To investigate the influencing factors and clinical applicability of ultrasound-guided attenuation parameter (UGAP) in evaluating non-alcoholic fatty liver disease (NAFLD), and to evaluate the application value of cardiovascular disease (CVD) prediction models in NAFLD patients.

This study included 204 NAFLD patients who underwent conventional two-dimensional ultrasound (US) and UGAP assessments from November 2022 to November 2023 at the First Affiliated Hospital of Harbin Medical University, and 73 healthy subjects were selected as a control group. All the subjects underwent two-dimensional ultrasound examination to evaluate the degree of hepatic steatosis, which was divided into S0~S3 grades. All subjects underwent UGAP examination to obtain UGAP values. Based on the presence or absence of CVD events, NAFLD patients were further divided into into two groups: 83 patients with CVD and 121 without. The differences of UGAP values among the S0~S3 groups were compared, and the independent risk factors affecting UGAP values were identified by univariate and multivariate linear regression analyses. Spearman correlation analysis was performed to evaluate the correlation between UGAP values and the degree of hepatic steatosis. The intraclass correlation coefficient (ICC) was used to evaluate the consistency of measurements between different operators. Logistic regression and nomogram models were used to analyze the risk factors for CVD in NAFLD patients, and receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the clinical efficacy of the model.

Among the 277 subjects, there were 73, 83, 86, and 35 cases in the S0~S3 groups, respectively. The differences in UGAP values among the S0~S3 groups were statistically significant (H=236.35, P<0.001). Multivariate linear regression analysis indicated that body mass index (BMI), total cholesterol (TC), triglycerides (TG), and the degree of hepatic steatosis were independent risk factors for UGAP (all P<0.05). The interrater ICC for UGAP was 0.977 (95% confidence interval [CI]: 0.972-0.982, P<0.001). Logistic regression analysis indicated that age, BMI, and UGAP values were independent influencing factors of CVD in NAFLD patients (P<0.05), and the area under the ROC curve of the nomogram model developed based on age, BMI, and UGAP values was 0.948 (95%CI: 0.920-0.977, P<0.001). The calibration curve showed that the actual prediction performance of the model was close to the ideal prediction performance.

UGAP values closely correlate with BMI and the degree of liver fatty degeneration, exhibiting excellent reproducibility among operators. The nomogram model constructed based on age, BMI, and UGAP values, intuitively evaluates the risk of concurrent CVD in NAFLD patients. Thus, UGAP provides a reliable basis for evaluating fatty liver and its severity and predicting the risk of CVD.