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Background While FIB-4 is recommended as an initial assessment tool for patients with MASLD, its real-world components are often measured on different dates. This study therefore aims to determine how varying time intervals between the component laboratory tests used impact the prognostic performance.Methods We examined two territory-wide cohorts from Hong Kong (HK) and United States (US). In the HK CDARS cohort, the baseline was the date of MASLD diagnosis. The US cohort using Veterans Health Administration (VHA) data set the first elevated alanine transaminase (ALT) measurement as the baseline. The performance of FIB-4 was examined using two approaches: i) ALT/ aspartate transaminase (AST) measured at baseline with platelets (PLT) measured 1 or 2 years apart; or ii) PLT measured at baseline with ALT/AST measured 1 or 2 years apart. The C-indices and subdistribution hazard ratios (SHRs) of FIB-4 to predict 5-year liver-related events (LREs) were estimated by the Fine-Gray subdistribution hazard model.Results 2,236 and 561,012 patients with MASLD were included in the HK CDARS cohort and the VHA cohort. In the CDARS cohort, the C-index of FIB-4 in predicting 5-year LRE (95% CI) were 0.770 (0.704-0.836) when all components were taken at baseline. The C-indices of FIB-4 were 0.756 and 0.766 when PLT was measured 1 and 2 years earlier, respectively. When ALT/AST were measured 1 or 2 years earlier, the values ranged from 0.755 to 0.770. These values were not significantly different from the reference when all tests were taken at baseline (all p>0.1). In the VHA cohort, with a lower C-index at baseline, FIB-4 values changed to 0.660-0.661 when PLT was measured at 1-2 year intervals, while remaining at 0.666 when ALT/AST were measured across two intervals. SHRs of FIB-4 with components at different intervals suggested a persistently significant association with LREs, and both cohorts demonstrated a stable time-dependent AUC of FIB-4 on predicting LREs at 5 years ( IDDF2026-ABS-0156 Figure 1. Performance and Hazards of FIB-4 with Time-varying Components in Two Cohorts).Conclusions The performance of FIB-4 remains stable when its components are measured at different time intervals, suggesting that FIB-4 can still be readily used even when not all components are available simultaneously.AUC, area under the receiver operating characteristic curve.Abstract IDDF2026-ABS-0156 Figure 1