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Aim of the study: Metabolic associated steatotic liver disease (MASLD) is one of the most frequent chronic liver diseases in the world; macrophage activation is reflected by increased expression of CD163, which sheds as serum soluble CD163 that is linked to hepatic steatosis, inflammation, and fibrosis. Aim of the study was assessment of liver macrophage activation and hepatic histopathological changes in patients with MASLD. Material and methods: A total of 30 patients with MASLD and equal numbers of age- and sex-matched healthy controls were enrolled in the study. Quantitative serum levels of soluble CD163 (sCD163) were determined using a commercially available standard sandwich ELISA kit. Core liver biopsies were obtained from patients with MASLD and evaluation of CD163 using anti-CD163 Ab-1 (Clone 10D6) - mouse monoclonal antibody. Results: The median sCD163 level was significantly higher in patients with MASLD compared with healthy controls. It can discriminate patients with MASLD from healthy controls at a cut-off value of 814 pg/ml. sCD163 level and intrahepatic total CD163-positive cell count were positively correlated, and both showed positive correlations with nonalcoholic fatty liver disease activity score. Conclusions: Soluble CD163 can discriminate MASLD patients from healthy controls after the exclusion of other causes of inflammation. [ABSTRACT FROM AUTHOR]