Abstract: Objective To evaluate the diagnostic value of shear wave elastography (SWE) combined with the aspartate aminotransferase-to-platelet ratio index (APRI) for identifying significant liver fibrosis (≥F2) in patients with alcohol-related liver disease (ALD), and to compare its diagnostic performance among different etiologies of chronic liver disease. Methods A total of 104 patients with ALD, 70 patients with chronic hepatitis B (CHB), 60 patients with metabolic dysfunction-associated fatty liver disease (MAFLD), and 50 healthy controls were enrolled. General characteristics, liver function parameters, PLT, APRI, and SWE levels were compared among the groups. APRI and SWE changes across different fibrosis stages in ALD were analyzed. ROC curves were used to assess the ability of APRI, SWE, and their combined model to predict significant fibrosis. Diagnostic performance was further compared across different etiologies. Pearson correlation analysis and binary logistic regression were applied to evaluate the correlation between APRI and SWE and their respective contributions to diagnosing significant fibrosis in ALD, CHB, and MAFLD. Results The ALT levels in the ALD, CHB, and MAFLD groups were (65.4±20.5) U/L, (90.4±35.0) U/L, and (78.4±25.0) U/L, respectively. AST levels were (72.6±25.6) U/L, (78.4±30.2) U/L, and (65.3±18.2) U/L, respectively. GGT levels were (128.5±40.8) U/L, (45.1±18.1) U/L, and (60.2±22.2) U/L, respectively. APRI scores were (0.78±0.30), (1.02±0.40), and (0.55±0.20), respectively, and SWE values were (9.6±3.2) kPa, (8.4±2.5) kPa, and (7.1±2.0) kPa, respectively. All these values were significantly higher than those of the normal control group (all P<0.05). In predicting significant liver fibrosis, SWE demonstrated higher AUC values than APRI, while the combination of both achieved the highest AUC (0.96 for ALD, 0.92 for CHB, and 0.88 for MAFLD), with sensitivities of 90.2%, 86.0%, and 82.6%, and specificities of 92.2%, 85.2%, and 80.8%, respectively. Correlation analysis revealed that SWE and APRI showed the strongest correlation in ALD (r=0.78), with SWE contributing the most to diagnosis (60.6%). In CHB, their contributions were similar (SWE 51.5%, APRI 48.5%), while in MAFLD, SWE contributed significantly more (65.7%) compared to APRI (34.3%). Conclusion SWE combined with APRI provides superior accuracy for diagnosing significant fibrosis in ALD compared with either serum-based markers or elastography alone, showing particularly strong performance in alcohol-related liver injury. The correlation and diagnostic contribution of SWE and APRI differ markedly across disease etiologies, indicating that etiology-based optimization of non-invasive fibrosis assessment strategies is necessary.

Key words: Alcohol-related liver disease, Chronic hepatitis B, Metabolic associated fatty liver disease, Shear wave elastography