Predicting Metabolic Dysfunction-Associated Steatotic Liver Disease using Machine Learning Methods: A Retrospective Cohort Study
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Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 30-40% of US adults and is the most common chronic liver disease. Although often asymptomatic, progression can lead to cirrhosis. The objective of the study was to develop and evaluate an electronic health record (EHR) based prediction model to support early detection of MASLD in primary care settings. Methods: We evaluated LASSO logistic regression, random forest, XGBoost, and a neural network model for MASLD prediction using clinical feature subsets from a large EHR database, including the top 10 ranked features. To reduce disparities in true positive rates across racial and ethnic subgroups, we applied an equal opportunity postprocessing method in a prediction model called MASLD EHR Static Risk Prediction (MASER). Results: This retrospective cohort study included 59,492 participants in the training data, 24,198 in the validating data, and 25,188 in the testing data. The LASSO logistic regression model with the top 10 features was selected for its interpretability and comparable performance. Before fairness adjustment, the model achieved AUROC of 0.84, accuracy of 78%, sensitivity of 72%, specificity of 79%, and F1-score of 0.617. After equal opportunity postprocessing, accuracy modestly increased to 81% and specificity to 94%, while sensitivity decreased to 41% and F1-score to 0.515, reflecting the fairness trade-off. Conclusions: MASER achieved competitive performance for MASLD prediction, comparable to previously reported ensemble and tree-based models, while using a limited and routinely collected feature set and a diverse study population. The model is designed to support early detection and potential integration into primary care workflows. MASER demonstrates EHR-ready MASLD prediction with fairness adjustments, supporting future primary care implementation pending prospective validation.