Increased serum uric acid to creatinine ratio is associated with metabolic dysfunction associated steatotic liver disease.

To investigate the correlation between the serum uric acid to creatinine ratio (SUA/SCr) and the severity of hepatic steatosis in individuals with MASLD. A total of 34,981 individuals were measured the controlled attenuated parameter (CAP) using transient elastography (TE), then we studied the association between SUA/SCr and the severity of hepatic steatosis defined with the value of CAP. A cohort of 2179 individuals without MASLD were followed up to investigate the relationship between SUA/SCr and the incidence of MASLD during the following 33 months. After adjusting for confounding factors, smooth fitting curve and threshold saturation analysis showed that SUA/SCr exhibited a significant positive correlation with CAP (P < 0.0001), with different inflection points in sex, BMI and age subgroups. Logistic regression analysis showed that SUA/SCr demonstrated a certain degree of predictive value for MASLD (P < 0.001). In followed-up population, individuals with higher SUA/SCr exhibited a significantly increased cumulative incidence of MASLD (P = 0.0008). Increased SUA/SCr levels are associated with the severity of hepatic steatosis in MASLD, is an independent risk factor for MASLD. Individuals with elevated levels of SUA/SCr are at a higher risk of developing MASLD. Maybe SUA/SCr could be considered as a useful biomarker for MASLD in clinical work, although the predictive value is limited, and further validation and combined usage with other markers are necessary.