Impact of Sex-Specific Cutoffs on Reducing Missed Advanced Fibrosis in Women with MASLD

Presented in 15th World Gastroenterology, IBD & Hepatology Conference from December 17-19, 2025, in Dubai, UAE & Online. 

Poster Presenter Name: Dr. Sae Kyung Joo , M.D., Ph.D.
Organization: Seoul National University College of Medicine
Location: South Korea
Research Interest: MASLD, fibrosis indices, non-invasive diagnosis
Category: Poster Presentation

Sae Kyung Joo, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.

Biography: Dr. Sae Kyung Joo is an Associate Professor in the Department of Gastroenterology at Boramae Medical Center, Seoul National University. Her research focuses on metabolic liver disease, non-invasive fibrosis assessment, and the impact of sex and metabolic risk factors on liver disease progression. She has authored multiple peer-reviewed publications in hepatology and gastroenterology.

Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Visit Poster Presenter page: https://gastroenterology.utilitarianconferences.com/speaker/dr-sae-kyung-joo

Background: Non-invasive fibrosis indices such as NFS, FIB-4, APRI, AAR, and BARD are commonly used to predict advanced fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). However, these indices were originally developed in NAFLD populations and rarely validated in sex-stratified contexts. Conventional cutoffs may underestimate advanced fibrosis in women, potentially delaying timely diagnosis and management.

Aim: To evaluate the diagnostic performance of sex-specific cutoffs for non-invasive fibrosis indices in MASLD, focusing on false-negative (FN) rates and discrimination accuracy.

Methods: This single-center retrospective study analyzed biopsy-proven MASLD patients (N=1,026). NFS, FIB-4, APRI, AAR, and BARD scores were calculated. Conventional cutoffs were compared with sex-specific thresholds derived from the Youden index. FN rates and AUROC values were analyzed separately in men and women.

 Results: Conventional cutoffs resulted in higher FN rates among women (22%) compared to men (12%). With sex-specific thresholds, FN rates in women were reduced from 28% to 14%, while in men NFS improved from 21% to 15%. AUROC values improved in women for NFS (0.813 → 0.873), FIB-4 (0.819 → 0.891), and AAR (0.774 → 0.844). These findings indicate that conventional thresholds may underestimate advanced fibrosis in women, whereas sex-specific cutoffs improve diagnostic sensitivity and overall discrimination.

Conclusion: Sex-specific cutoffs for non-invasive fibrosis indices enhance diagnostic performance in MASLD, particularly by reducing false negatives in women. Implementing gender-tailored thresholds in clinical practice may optimize risk stratification and facilitate earlier detection of advanced fibrosis, leading to more accurate and equitable care.

 Figure 1. AUROC comparison: conventional vs sex-specific cutoffs

Figure 2. Sex-stratified changes in false negative rates

 Figure Legends: Figure 1. Comparison of diagnostic performance (AUROC) of conventional versus sex-specific cutoffs for non-invasive fibrosis indices. Sex-specific cutoffs demonstrated improved discrimination, particularly in women with MASLD.

Figure 2. False negative rates of fibrosis indices according to sex. Conventional cutoffs led to a higher proportion of false negatives in women, while sex-specific cutoffs reduced missed advanced fibrosis..

Keywords: MASLD, advanced fibrosis, sex-specific cutoff, non-invasive index, diagnostic accuracy

References:
[1] Sanyal AJ, et al. Clin Gastroenterol Hepatol. 2023;21:2026-2039
[2] Lee J, et al. Liver Int. 2021;41:261-270
[3] Wu Y, et al. J Hepatol. 2021;74:247-248

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