Non-invasive liver fibrosis markers are significantly positively correlated with carotid plaque and its vulnerability in metabolic dysfunction-associated steatotic liver disease patients

This study investigated the association between non-invasive liver fibrosis scores and carotid plaque vulnerability in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) using parameters routinely available in clinical practice. This cross-sectional study enrolled 4631 patients with MASLD from the Health Examination Center of Northern Jiangsu People’s Hospital. Carotid ultrasound assessed plaque presence and vulnerability, while the NAFLD Fibrosis Score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI) quantified the degree of liver fibrosis. Multivariable logistic regression, restricted cubic splines (RCS) analysis, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and subgroup analyses systematically evaluated the relationship between liver fibrosis severity and vulnerable carotid plaques. Multivariable logistic regression demonstrated a significant, graded association between higher liver fibrosis scores and increased prevalence of vulnerable carotid plaques (all P < 0.05). ROC curve analysis revealed that FIB-4 and NFS exhibited moderate predictive value for vulnerable carotid plaques, with performance exceeding that of traditional risk factors including age. RCS analysis confirmed a linear positive relationship between FIB-4 and NFS and the presence of vulnerable plaques ( P for nonlinear > 0.05). Subgroup analyses revealed no significant interactions modifying this positive association (all P for interaction > 0.05). Hepatic fibrosis severity in patients with MASLD demonstrates a significant, direct, and graded positive correlation with vulnerable carotid plaque presence. Both FIB-4 and NFS outperform traditional risk factors such as age in predicting plaque vulnerability. Integrating these simple, non-invasive scores into routine MASLD assessments provides a practical, decision-support tool to prompt targeted carotid ultrasound screening, particularly in resource-constrained primary care settings where it can optimize the allocation of limited diagnostic resources.