Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
Hepatol Commun. 2022 Apr;6(4):898-909. doi: 10.1002/hep4.1837. Epub 2021 Oct 25.
Cirrhosis, a rising cause of death in the United States, has an extended preclinical phase characterized by progressive liver fibrosis. Despite the developments in noninvasive fibrosis measurement, there is no recommended screening, in part due to an incomplete understanding of the disease epidemiology on a national scale. Herein, we aim to define the prevalence of liver fibrosis and compare strategies to identify the at-risk population. We analyzed 4,510 US adults with complete liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) in the 2017-2018 National Health and Nutrition Examination Survey to estimate the disease burden of increased liver stiffness. An estimated 11.6 million (95% confidence interval [C.I.], 8.1-15.0 million) US adults had LSM ≥9.5 kPa, indicating advanced fibrosis and representing 1 in every 18 adults. Among them, 7.1 million (95% CI, 5.0-9.1 million) had LSM ≥12.5 kPa, which is concerning for cirrhosis. LSM ≥9.5 kPa is associated with male sex (S), history of other liver diseases (O), diabetes (D), advanced age (A), and an elevated BMI (B). A simple SODA-2B score had a sensitivity of 96.4% in identifying individuals at risk for advanced cirrhosis (LSM ≥9.5 kPa) and a negative predictive value of 99.3% in stratifying more than half of the adult population. When the liver function test (LFT) is available, the inclusion of abnormal LFT and elevated fibrosis-4 index can further increase screening efficiency. Conclusion: Elevated liver stiffness is prevalent among US adults. A SODA-2B score can risk stratify adults for VCTE-based fibrosis screening.
肝硬化是美国不断上升的死亡原因之一，其具有进展性肝纤维化的扩展临床前阶段。尽管在无创性纤维化测量方面取得了进展，但由于对全国范围内疾病流行病学的认识不完整，目前还没有推荐的筛查方法。在此，我们旨在确定肝纤维化的流行率，并比较确定高危人群的策略。我们分析了 2017-2018 年全国健康和营养调查中 4510 名接受振动控制瞬时弹性成像（VCTE）完整肝硬度测量（LSM）的美国成年人，以估计增加的肝硬度的疾病负担。估计有 1160 万（95%置信区间[CI]，810 万至 1500 万）名美国成年人的 LSM≥9.5kPa，表明存在晚期纤维化，占每 18 名成年人中的 1 名。其中，710 万人（95%CI，500 万至 910 万）的 LSM≥12.5kPa，这令人担忧是否患有肝硬化。LSM≥9.5kPa 与男性（S）、其他肝脏疾病史（O）、糖尿病（D）、年龄较大（A）和升高的 BMI（B）有关。简单的 SODA-2B 评分在识别有进展性肝硬化风险（LSM≥9.5kPa）的个体时具有 96.4%的敏感性，在分层超过一半的成年人口时具有 99.3%的阴性预测值。当肝功能测试（LFT）可用时，包括异常的 LFT 和升高的纤维化-4 指数可以进一步提高筛查效率。结论：美国成年人中肝硬度升高较为普遍。SODA-2B 评分可对 VCTE 纤维化筛查进行风险分层。
