Steatotic liver disease indices for cardiovascular event prediction: Panasonic cohort study 28.

Background: Noninvasive hepatic steatosis indices may aid in cardiovascular risk assessment; however, their comparative predictive abilities remain uncertain. Methods: We analyzed data from 134,604 Japanese adults aged ≥ 40 years who underwent health checkups between 2011 and 2020. Four indices (the ZJU index, Hepatic Steatosis Index (HSI), Fatty Liver Index (FLI), and K-NAFLD score) were evaluated for their ability to predict major adverse cardiovascular events (MACE). Time-dependent receiver operating characteristic (ROC) analyses based on 10-year follow-up were performed using univariable Cox models including each index. The area under the ROC curve (AUC) was calculated to assess predictive performance. We compared AUCs between pairs of indices to determine which performed better, using 1,000 bootstrap resamples and 95 % confidence intervals. Results: During a total follow-up period of approximately 860,000 person-years, 3,532 participants developed MACE (incidence: 4 per 1,000 person-years). All indices were significantly associated with MACE incidence. FLI showed the highest AUC for predicting MACE (0.615), followed by the K-NAFLD score (0.613), with optimal cutoffs of 23.33 and -2.61, respectively. Both indices outperformed the ZJU index and HSI, with statistically significant differences in AUCs. No significant difference was observed between FLI and the K-NAFLD score. Conclusions: The FLI and K-NAFLD score demonstrated relatively better predictive performance for cardiovascular events compared with the ZJU index and HSI. These findings may support their use in public health screening and clinical risk stratification.