Exploring the severity and risk factors of non-alcoholic fatty liver disease using the SAF scoring system

Xinxin Li; Shiyu Wang; Ziyu Zhang; Wen Deng; Yaqin Zhang; Weihua Cao; Xin Wei; Zixuan Gao; Linmei Yao; Shuojie Wang; Wei Yi; Yao Xie; Minghui Li

doi:10.3389/fmed.2025.1510679

Exploring the severity and risk factors of non-alcoholic fatty liver disease using the SAF scoring system

Front Med (Lausanne). 2025 Mar 28:12:1510679. doi: 10.3389/fmed.2025.1510679. eCollection 2025.

Authors

Xinxin Li^#¹, Shiyu Wang^#¹, Ziyu Zhang^#¹, Wen Deng^#¹, Yaqin Zhang¹, Weihua Cao¹, Xin Wei¹, Zixuan Gao¹, Linmei Yao¹, Shuojie Wang¹, Wei Yi², Yao Xie^{1

3

4}, Minghui Li^{1

3

4}

Affiliations

¹ Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
² Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
³ HBV Infection, Clinical Cure and Immunology Joint Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
⁴ Department of Hepatology Division, Peking University Ditan Teaching Hospital, Beijing, China.

^# Contributed equally.

Abstract

Objective: The steatosis, activity, and fibrosis (SAF) score is a histological scoring system developed by the European Association for the Study of the Liver to evaluate liver biopsy samples in cases of non-alcoholic fatty liver disease (NAFLD). Based on histopathological results and SAF scores, NAFLD patients were categorized into mild, moderate, and severe groups. We compared the differences between these groups and identified the risk factors influencing lesion severity.

Methods: We gathered data from 539 NAFLD patients who underwent percutaneous liver biopsy confirmation at Beijing Ditan Hospital between January 2018 and December 2022. All biopsies were graded according to the SAF scoring system, and the severity of the disease was classified as mild, moderate, or severe. We compared the differences in gender, age, BMI, history of diabetes, history of hypertension, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum cholesterol levels, and other factors among NAFLD patients with varying degrees of disease severity. Additionally, we explored the risk factors that influenced the severity of lesions.

Results: A total of 539 patients were enrolled in this study, with ages ranging from 6 to 79 years. Among them, there were 325 men and 214 women in an average age of 39 ± 13 years. The patients were divided into three groups based on disease severity: mild NAFLD group (162 cases), moderate NAFLD group (210 cases), and severe NAFLD group (167 cases). The results showed significant differences between the three groups in terms of age composition, high-calorie diet, family history of hypertension, ALT, AST, GGT, total bile acids, cholinesterase, glycosylated albumin, blood glucose, uric acid, type III procollagen, serum human laminin, liver stiffness, and hepatic steatosis.

Conclusion: BMI, uric acid, AST, type III procollagen, liver stiffness, and hepatic steatosis play critical roles in the progression of NAFLD and contribute to high pathological SAF scores in NAFLD patients.

Keywords: SAF scoring system; body mass index (BMI); liver fibrosis; liver stiffness; metabolic syndrome; non-alcoholic fatty liver disease (NAFLD); risk factors; uric acid.