Letter to the Editor: Enhancing fibrosis prediction in metabolic dysfunction-associated steatotic liver disease: The potential of combined biomarker approaches

Abstract

This letter discusses a study by Duarte et al, published in the World Journal of Hepatology. evaluating routine inflammatory markers for predicting liver fibrosis in metabolic dysfunction-associated steatotic liver disease. While parameters like neutrophil-to-lymphocyte ratio, systemic inflammation response index, and C-reactive protein showed significant associations with fibrosis, their individual diagnostic accuracy remained limited (area under the receiver operating characteristic curve < 0.7), highlighting the inadequacy of systemic inflammatory surrogates for organ-specific pathology. We argue for a shift toward integrative diagnostics, proposing a mechanism-informed strategy that combines accessible systemic markers (e.g., high-sensitivity-C-reactive protein) with novel hepatic biomarkers (e.g., N-terminal propeptide of type III collagen, liver-enriched microRNAs, fatty acid-binding protein 4). This approach enables multidimensional assessment, balancing accessibility with improved specificity and dynamic monitoring potential. Future priorities include validating combined panels against clinical outcomes, establishing actionable thresholds, and developing personalized algorithms. Integrating biomarkers across biological domains promises to advance metabolic dysfunction-associated steatotic liver disease management toward precision risk stratification and dynamic monitoring, improving patient prognosis.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Liver fibrosis; Biomarkers; Diagnostic strategy; Inflammatory indices

Core Tip: This letter highlights the limited diagnostic accuracy of conventional markers (e.g., neutrophil-to-lymphocyte ratio and C-reactive protein) for predicting liver fibrosis in metabolic dysfunction-associated steatotic liver disease. To advance precision management, we propose a shift toward an integrated diagnostic paradigm. This strategy combines accessible systemic inflammation indices with novel biomarkers reflecting specific hepatic processes, such as N-terminal propeptide of type III collagen for fibrogenesis, liver-specific microRNAs, and metabolic proteins, such as fatty acid-binding protein 4. Future research should prioritize validating such mechanism-informed combinations to enable multidimensional risk assessment, establish actionable clinical thresholds, and guide personalized monitoring and intervention, ultimately improving prognosis in this heterogeneous patient population.