The utilization of non-invasive tests in the diagnosis and management of steatotic liver disease and their concordance with current clinical guidelines

Objective: Given the demographic characteristics and comorbidities of the Turkish population, it is evident that there is a high risk for steatotic liver disease. The insidious progression of this condition can lead to significant medical and economic burdens. Early recognition and timely interventions through regular follow-ups are crucial to prevent severe medical and economic consequences. This study aims to characterize patients who present to Koç University Hospital with complaints and complications related to steatotic liver disease or who are being followed up for this condition. Furthermore, it seeks to evaluate their follow-up and treatment in light of current literature and guidelines and to identify potential strategic modifications in our clinical practice. Materials and Methods: This study is a cross-sectional observational investigation. The study population was selected from patients with steatotic liver disease who were seen at the Internal Medicine and Gastroenterology Outpatient Clinics of Koç University Hospital. Demographic information and relevant clinical data (liver fibrosis and steatosis parameters, ultrasonographic and endoscopic imaging results) of the participants were obtained from the hospital clinical portal used in our institution. Following the characterization of the participant cohort, the alignment of clinical outcomes with current recommendations and criteria was compared. Results: Data from 115 out of 570 patients (73.0% male, median age 51) diagnosed with steatotic liver disease were analyzed. The most prevalent diagnoses were MAFLD (61.7%) and MASH cirrhosis (19.1%). A significant positive correlation was observed between FIB-4 and liver stiffness (ρ = 0.484, r = 0.581, p < 0.001), while a weak inverse relationship was found with steatosis (r = –0.199, p = 0.033). FIB-4 risk groups and ultrasonographic steatosis grades did not show a significant association with steatosis severity or fibrosis stages (p > 0.05). However, FIB-4 and USG steatosis grade together significantly predicted CAP (F(3,111), p < 0.001) and explained 38.4% of the variance in LSM (R² = 0.384, p < 0.001). In patients with portal hypertension, FIB-4 (median 3.12 vs 1.47, p < 0.001) and LSM (median 17.8 vs 6.4 kPa, p < 0.001) were significantly higher. Conclusion: Steatotic liver disease is increasingly encountered in clinical practice. In this patient population, risk assessment and subsequent follow-up according to this assessment are necessary for accurate diagnosis and selection of appropriate treatment methods. Although invasive methods remain the imperfect gold standard, non-invasive methods appear to be adequate and successful in the management of these patients. To ensure efficient resource utilization and avoid unnecessary invasive procedures, non-invasive methods should be more widely adopted in clinical practice, and further validation studies related to these methods are warranted. Keywords: Steatohepatitis, fibrosis, portal hypertension, transient elastography