Elevated uric acid levels are associated with an increased risk of fibrosis in MASLD

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. Uric acid (UA) is a well-known component of metabolic dysfunction and also implicated as a risk factor for MASLD. Herein, elevated uric acid levels can increase insulin resistance, inflammatory response and oxidative stress in the liver, thereby promoting MASH progression. However, the role of uric acid in risk stratification of MASLD patients remains unclear.

Uric acid levels were assessed in 96 MASLD patients and associated with established non-invasive surrogates of liver fibrosis (e.g. FIB-4, VTCE/CAP). Patients on uric acid-lowering therapy were excluded. Elevated UA was defined as≥360 μmol/l.

UA levels showed a linear correlation with increased CAP (r=0.27; p=0.0094) and median values (r=0.23; p=0.032), suggesting greater hepatic steatosis and fibrosis. Among patients at increased risk of fibrosis (FIB-4≥1.3 or median≥8 kPa), elevated UA was associated with an increase in non-invasive tests. Patients above the 75th percentile of UA (≥410 μmol/l) showed significantly higher FIB-4 and median in the at-risk population compared to the 25th percentile. Interestingly, patients with elevated UA had significantly higher triglycerides and lower HDL cholesterol. Of note, UA levels were independent of diabetes status and body weight, but patients with elevated UA levels had higher creatinine levels.

Conclusion: Uric acid levels significantly correlate with hepatological outcome in MASLD patients at high fibrosis risk, suggesting a potential relevance for risk stratification. Further longitudinal studies are needed to assess its prognostic value.