Evaluating the FIB-4 score as a screening tool for NAFLD in PCOS: a cross-sectional study

Kovacevic Valentina Elezovic; Sanja Ognjanovic; Bojana Popovic; Dusan Ilic; Palibrk Milica Opalic; Lena Radic; Katarina Krstic; Djuro Macut

doi:10.1530/endoabs.110.EP1299

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Endocrine Abstracts (2025) 110 EP1299 | DOI: 10.1530/endoabs.110.EP1299

ECEESPE2025 ePoster Presentations Reproductive and Developmental Endocrinology (128 abstracts)

Evaluating the FIB-4 score as a screening tool for NAFLD in PCOS: a cross-sectional study

Valentina Elezovic Kovacevic ^1,2 , Sanja Ognjanovic ^1,2 , Bojana Popovic ^1,2 , Dusan Ilic ¹ , Milica Opalic Palibrk ¹ , Lena Radic ¹ , Katarina Krstic ¹ & Djuro Macut ^1,2

Author affiliations

¹Clinic of endocrinology, diabetes and metabolic diseases, Clinical Center of Serbia, Belgrade, Serbia, Departemet of neuroendocrine tumors and hereditary cancer syndroms, Belgrade, Serbia; ²Faculty of Medicine University of Belgrade, Belgrade, Serbia

JOINT2996

Patients with polycystic ovary syndrome (PCOS) have an increased risk of non-alcoholic fatty liver disease (NAFLD), which often results in more severe hepatic steatosis and liver fibrosis. The prevalence of NAFLD in PCOS patients ranges from 34% to 70%, and the possible mechanisms behind this association involve insulin resistance, inflammation, and hyperandrogenism. This study aimed to analyze the FIB-4 score, a widely recognized tool for assessing NAFLD risk, in a cohort of women with PCOS.

Methods: PCOS was diagnosed according to the ESHRE/ASRM criteria, and patients were classified into four phenotypes: PCOS-A (anovulation, hyperandrogenism, polycystic ovary morphology), PCOS-B (anovulation, hyperandrogenism), PCOS-C (hyperandrogenism, polycystic ovary morphology), and PCOS-D (anovulation, polycystic ovary morphology). FIB-4 score was calculated to assess NAFLD risk, with a cut-off value of >1.3 used to suggest advanced fibrosis.

Results: A total of 168 women with PCOS were included in the study, with a mean age of 26.1±6.4 years and a mean BMI of 24.5±5.8 kg/m². The most prevalent phenotypes were PCOS-A (40.7%), followed by PCOS-D (22.6%), PCOS-C (23.2%), and PCOS-B (13.6%). The mean HOMA score was 3.3±1.86, and 58.8% of patients had confirmed hyperandrogenism. The median FIB-4 score was 0.397±0.152, and no participants had a FIB-4 score above 1.3. Statistically significant differences were observed only between phenotypes A and C (P <0.05). Significant correlations were found between FIB-4 and SHBG (ρ=0.335, P <0.001), free androgen index (FAI) (ρ=-0.257, P <0.001), triglycerides (ρ = 0.199, P < 0.05) and androstendione (ρ=-0.259, P <0.001). In multiple regression analysis, SHBG (B=0.001, Beta=0.184, P <0.05) and androstendione (B=0.002, Beta=0.277, P <0.05) showed small but significant associations with FIB-4, whereas FAI and triglycerides did not appear to be significant predictors.

Conclusion: The study suggests that the FIB-4 score may not be an effective screening tool for NAFLD in younger women with PCOS, as none of the participants had a FIB-4 score above 1.3. Although SHBG and androstendione showed small but statistically significant correlations with FIB-4, further research is needed for better understanding the role of metabolic factors in NAFLD risk in PCOS.