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Six noninvasive liver fibrosis scores, including LiverRisk, metabolic dysfunction-associated fibrosis 5 (MAF-5), nonalcoholic fatty liver disease fibrosis score (NFS), Fibrosis-4 (FIB-4), steatosis-associated fibrosis estimator (SAFE), and aspartate aminotransferase-to-platelet ratio index (APRI), were evaluated. Logistic regression was used to assess associations with advanced CKM syndrome. Cox proportional hazards models and Fine\u2013Gray competing-risk models were applied to evaluate associations with all-cause mortality and cardiovascular disease (CVD) mortality, respectively. Restricted cubic spline, subgroup, sensitivity, and incremental prediction analyses were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The participants had a mean age of 50.82\u2009\u00b1\u20090.22 years, 51.85% were female, and 12.30% had advanced CKM syndrome. During a median follow-up of 7.42 years, 599 all-cause deaths and 166 CVD deaths occurred. Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were significantly associated with advanced CKM syndrome, whereas APRI was not. All six fibrosis scores were significantly associated with increased all-cause mortality. For CVD mortality, higher LiverRisk, NFS, FIB-4, and SAFE were significantly associated with increased risk, with corresponding sHRs of 3.84, 3.54, 2.25, and 3.63, respectively (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05), whereas MAF-5 and APRI were not significantly associated with CVD mortality. These findings were supported by dose-response analyses and remained materially unchanged in sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher LiverRisk, MAF-5, NFS, FIB-4, and SAFE scores were associated with advanced CKM syndrome, whereas all six scores were associated with all-cause mortality. LiverRisk, NFS, FIB-4, and SAFE showed more consistent associations with CVD mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-06148-2","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T02:47:09Z","timestamp":1782096429000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of noninvasive liver fibrosis scores with severity and outcomes among individuals with cardiovascular-kidney-metabolic syndrome: evidence from the NHANES 2005\u20132018"],"prefix":"10.1186","volume":"26","author":[{"given":"Yue","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiwen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengli","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"20","key":"6148_CR1","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1161\/CIR.0000000000001186","volume":"148","author":"CE Ndumele","year":"2023","unstructured":"Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Despres JP, et al. 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As this study used deidentified, publicly available NHANES data, it was deemed exempt from additional review under ethical guidelines for secondary data analysis.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"765"}}