Abstract: Background　Metabolic-associated fatty liver disease (MAFLD) is a highly prevalent chronic liver disease worldwide. Liver cirrhosis, as its severe progressive outcome, poses a serious threat to patients' health. Non-invasive scoring indicators such as aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), and liver stiffness measurement (LSM) are widely used in clinical practice due to their convenience. However, their value in evaluating the risk of cirrhosis in MAFLD patients and the impact of chronic hepatitis B virus (HBV) infection remain unclear. Objective　To explore the correlation between non-invasive indicators including APRI and FIB-4 and the prevalence of cirrhosis in MAFLD patients, clarify the related risk factors and the modifying effect of chronic HBV infection, so as to provide evidence for the accurate clinical assessment of cirrhosis risk. Methods　Patients diagnosed with fatty liver who were admitted to the Fifth Medical Center of PLA General Hospital from January 2023 to July 2024 were screened. General clinical data, laboratory indicators, and imaging parameters of the patients were collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors associated with the prevalent status of liver cirrhosis. Stratified analysis was conducted to explore the effect modification of chronic HBV infection. Additionally, the diagnostic efficacy of APRI and FIB-4 was compared using receiver operating characteristic (ROC) curves. Results　A total of 1 265 patients diagnosed with fatty liver via abdominal imaging were retrospectively enrolled. After excluding patients with incomplete data and those who did not meet the diagnostic criteria for MAFLD, 435 MAFLD patients were finally included in the study, among whom 269 cases were non-cirrhotic and 166 cases were cirrhotic. The study cohort consisted of 261 males (60%) and 174 females (40%), with a mean age of 49.5 years. Significant differences were observed between the cirrhotic group and the non-cirrhotic group in terms of gender ratio, age, proportion of chronic HBV infection, platelet (PLT) levels, and liver fibrosis-related indicators (FIB-4, APRI, liver stiffness measurement LSM) (all P<0.05). Multivariate logistic regression analysis demonstrated that age ≥ 60 years (OR=3.216, P=0.001), chronic HBV infection (OR=2.450, P=0.000), male (OR=2.397, P=0.001), and LSM ≥ 12.0 kPa (OR=9.183, P<0.001) were independent factors associated with prevalent cirrhosis. No significant correlation was identified between APRI and cirrhosis (P>0.05), nor between UAP and cirrhosis (P>0.05). ROC curve analysis showed that in the total population, the area under the curve (AUC) of FIB-4 for diagnosing cirrhosis was 0.735, which was significantly higher than that of APRI (0.658, P<0.001). In the subgroup without HBV infection, the AUC of FIB-4 was remarkably superior to that of APRI (0.855 vs 0.740, P<0.001). However, in the subgroup with HBV co-infection, the diagnostic efficacy of both indicators was decreased, and no significant difference was found between them (P=0.061). Conclusion　Age ≥ 60 years, male, chronic HBV infection, and high LSM value are key independent risk factors for the prevalence of cirrhosis in MAFLD patients. FIB-4 has better diagnostic efficacy for cirrhosis in MAFLD patients than APRI, and the status of chronic HBV infection significantly affects its diagnostic value. In the absence of HBV infection, FIB-4 has a better risk identification efficacy and can be used as the preferred indicator for the non-invasive clinical assessment of cirrhosis risk in MAFLD patients.