Abstract: Objective The aim of this study was to investigate evaluation of hepatic steatosis by ultrasound-derived fat fraction (UFF) in combination with remnant cholesterol/high-density lipoprotein cholesterol (RC/HDL-C) ratio in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods A total of 103 patients with MAFLD were admitted to our hospital between January 2022 and March 2025, and all underwent liver biopsy. UFF was detected by color Doppler ultrasound, and blood biochemical parameter were detected and RC/HDL-C ratio was calculated. Factors impacting severity of hepatic steatosis in MAFLD patients was analyzed by multivariate Logistic regression analysis, and diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 103 patients with MAFLD, liver histopathological examination found liver steatosis S1 in 41 cases, S2 in 38 cases and S3 in 24 cases; there was a significant difference as respect to body mass index among the three groups (P<0.05); UFF and RC/HDL-C ratio in patients with S3 liver steatosis were (36.6±5.7)% and (1.0±0.3), both significantly higher than [(24.8±4.1)% and (0.7±0.2), respectively, P＜0.05] in those with S2 or [(15.7±3.3)% and (0.5±0.1), respectively, P＜0.05] in those with S1; multivariate Logistic regression analysis showed that UFF(OR=2.694,95%CI:1.473-4.927) and RC/HDL-C ratio (OR=2.115,95%CI:1.415-3.161) were both independent impacting factors for ≥S2 liver steatosis; the AUC was 0.863, with sensitivity of 87.1% and specificity of 70.7%, when UFF in combination with RC/HDL-C ratio was set in predicting S2/S3 liver steatosis. Conclusion Diagnostic performance of combination of UFF and RC/HDL-C ratio is satisfactory in predicting severe liver steatosis in patients with MAFLD, which might help clinicians make further intervention steps.

Key words: Metabolic dysfunction-associated fatty liver disease, Ultrasound-derived fat fraction, Remnant cholesterol/high-density lipoprotein cholesterol ratio, Diagnosis