Time-dependent predictive accuracy of noninvasive liver scores for chronic kidney disease onset in metabolic dysfunction-associated steatotic liver disease

Table 1 Baseline characteristics of metabolic associated steatotic liver disease

Characteristics	Total (n = 922)	5-year CKD (n = 66)	Non-CKD (n = 856)	P value
Age (years)	54.5 (44.0, 62.0)	65.5 (57.0, 70.0)	54.0 (44.0, 61.0)	< 0.001
Male	447 (48.5)	32 (48.5)	415 (48.5)	1.000
BMI (kg/m2)	26.4 (24.0, 29.4)	26.6 (24.2, 30.0)	26.3 (24.0, 29.3)	0.374
Obesity	763 (82.8)	56 (84.9)	707 (82.6)	0.640
Hypertension	518 (57.2)	48 (72.7)	470 (56.0)	0.008
Diabetes	248 (31.3)	23 (37.1)	225 (30.8)	0.306
Dyslipidemia	509 (61.0)	38 (58.5)	471 (61.3)	0.658
eGFR (mL/minute/1.73 m2)	94.0 (82.1, 103.0)	69.0 (64.0, 77.0)	95.0 (85.0, 104.0)	< 0.001
AST (U/L)	29.0 (23.0, 39.0)	31.0 (24.0, 47.0)	29.0 (22.5, 39.0)	0.167
ALT (U/L)	34.0 (21.0, 53.0)	30.5 (21.0, 50.0)	35.0 (21.0, 53.0)	0.421
CAP (dB/m)	299.0 (275.0, 328.0)	308.5 (276.0, 336.0)	299.0 (275.0, 328.0)	0.488
LSM (kPa)	6.8 (5.1, 10.8)	10.1 (6.3, 14.3)	6.7 (5.0, 10.4)	< 0.001
NFS	-1.5 (-2.5, -0.5)	-0.4 (-1.2, 0.5)	-1.5 (-2.5, -0.6)	< 0.001
NFS group				< 0.001
Low	460 (49.9)	13 (19.7)	447 (52.2)
Intermediate	369 (40.0)	39 (59.1)	8.6)
High	93 (10.1)	14 (21.2)	79 (9.2)
FIB-4	1.2 (0.8, 1.8)	1.7 (1.2, 2.7)	1.1 (0.8, 1.7)	< 0.001
FIB-4 group				< 0.001
Low	531 (57.6)	17 (25.8)	514 (60.0)
Intermediate	276 (29.9)	34 (51.5)	242 (28.3)
High	115 (12.5)	15 (22.7)	100 (11.7)
ALBI	-3.0 (-3.2, -2.7)	-2.9 (-3.1, -2.6)	-3.0 (-3.2, -2.7)	0.006
ALBI grade				0.105
Grade 1	774 (84.0)	50 (75.8)	724 (84.6)
Grade 2	137 (14.9)	14 (21.2)	123 (14.4)
Grade 3	11 (1.1)	2 (3.0)	9 (1.0)

Data are presented as n (%) or median (interquartile range). P value by Pearson’s χ² test or Mann-Whitney U test. Significant level at P < 0.05. CKD: Chronic kidney disease; ALT: Alanine aminotransferase; ALBI: Albumin-Bilirubin; AST: Aspartate aminotransferase; BMI: Body Mass Index; CAP: Controlled Attenuation Parameter; eGFR: Estimated glomerular filtration rate; FIB-4: Fibrosis-4; LSM: Liver stiffness measurement; NFS: Non-alcoholic fatty liver disease fibrosis score.

Table 2 Prognostic performance of non-invasive liver disease assessments for chronic kidney disease in metabolic associated steatotic liver disease patients (n = 922)

Scores	Cumulative CKD occurrence stage ≥ 3
	1-year	2-year	3-year	4-year	5-year
NFS
AUROC	0.77	0.78	0.79	0.73	0.73
(95%CI)	(0.67-0.85)	(0.71-0.85)	(0.73-0.85)	(0.65-0.81)	(0.65-0.81)
Standard cutoff values	≥ -1.455	≥ -1.455	≥ -1.455	≥ -1.455	≥ -1.455
Sensitivity (%)	84.21	88.24	89.13	79.31	80.30
Specificity (%)	47.21	47.79	48.47	47.85	41.97
FIB-4
AUROC	0.72	0.76	0.77	0.70	0.73
(95%CI)	(0.61-0.80)	(0.69-0.82)	(0.70-0.82)	(0.63-0.78)	(0.65-0.79)
Standard cutoff values	≥ 1.30	≥ 1.30	≥ 1.30	≥ 1.30	≥ 1.30
Sensitivity (%)	73.68	82.35	82.61	75.86	74.24
Specificity (%)	53.37	54.20	54.58	53.31	41.45
LSM
AUROC	0.67	0.66	0.67	0.64	0.65
(95%CI)	(0.53-0.78)	(0.56-0.75)	(0.59-0.76)	(0.56-0.72)	(0.57-0.72)
Standard cutoff values	≥ 8.0	≥ 8.0	≥ 8.0	≥ 8.0	≥ 8.0
Sensitivity (%)	63.16	64.71	65.22	62.07	59.09
Specificity (%)	58.06	57.58	56.71	55.79	51.81
ALBI
AUROC	0.57	0.56	0.54	0.57	0.58
(95%CI)	(0.45-0.71)	(0.48-0.65)	(0.46-0.64)	(0.48-0.67)	(0.49-0.66)
Standard cutoff values	≥ -2.61	≥ -2.61	≥ -2.61	≥ -2.61	≥ -2.61
Sensitivity (%)	15.79	17.65	21.74	25.86	25.76
Specificity (%)	80.35	79.02	78.62	77.65	79.02
Comparison of AUROCa
NFS vs FIB-4	0.147	0.521	0.384	0.329	0.838
NFS vs LSM	0.059	0.012a	0.008a	0.034a	0.038a
NFS vs ALBI	0.018a	<0.001a	<0.001a	0.003a	0.005a

^aP values were derived from the ratio of the observed difference in AUROC to its bootstrap standard error, approximated by a standard normal distribution. Significant levels were set at P < 0.05.

ALBI: Albumin-Bilirubin; AUROC: Area under the receiver operating characteristic curve; LSM: Liver stiffness measurement; FIB-4: Fibrosis-4; CI: Confidence interval; CKD: Chronic kidney disease; NFS: Non-alcoholic fatty liver disease fibrosis score.