ArticleThe Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology2026
Diagnostic Value of Serum Fibroblast Growth Factor 21 Combined with Fibrosis-4 Index for Hepatic Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease.
Article in The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease, with significant fibrosis (≥F2) strongly associated with adverse outcomes. The current study evaluated the diagnostic value of serum fibroblast growth factor 21 (FGF-21) combined with the fibrosis-4 index (FIB-4) for the assessment of hepatic fibrosis in patients with MASLD. Materials and Methods: A total of 125 patients with MASLD were enrolled (91 patients with F0-F1 fibrosis and 34 patients with F2-F4 fibrosis). Independent risk factors for significant fibrosis were identified using multivariate logistic regression. A combined diagnostic model was developed and validated using bootstrap resampling (500 iterations). Diagnostic performance was evaluated using receiver operating characteristic curve analysis. Results: Compared to the F0-F1 fibrosis group, patients with F2-F4 fibrosis had significantly higher waist circumference (WC), gammaglutamyl transferase (GGT), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol, FIB-4 index, and FGF-21 levels and significantly lower high-density lipoprotein cholesterol (HDL-C) levels. Multivariate analysis identified FIB-4, FGF-21, WC, GGT, and HOMA-IR as independent risk factors, whereas HDL-C was identified as a protective factor. The combined model achieved an area under the curve of 0.806 (95% CI: 0.727-0.886), outperforming FIB-4 (0.743) and FGF-21 (0.735) alone. At the optimal cutoff determined by the Youden index, the combined model maintained comparable specificity while significantly improving sensitivity to 94.12%. The model also demonstrated balanced performance under both specificity-driven and sensitivitydriven strategies. Conclusion: Combining FGF-21 with FIB-4 improved diagnostic accuracy for significant fibrosis in MASLD, providing a practical, noninvasive tool for early risk assessment and patient stratification.
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