Transplantation and Liver Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Finnish Institute for Health and Welfare, Helsinki, Finland.
United European Gastroenterol J. 2022 Nov;10(9):1020-1028. doi: 10.1002/ueg2.12323. Epub 2022 Nov 1.
BACKGROUND & AIMS: Liver fibrosis screening is recommended in high-risk populations, but the optimal definition of "high risk" remains to be established. We compared the performance of several risk-stratification strategies in a population-based setting.
Data were obtained from the Finnish population-based health examination surveys Health 2000 and FINRISK 2002-2012. The Chronic Liver Disease Risk Score (CLivD) was compared to previously published risk-stratification strategies based on elevated liver enzymes, alcohol use, diabetes, fatty liver index, body mass index, and/or metabolic risk factors for their ability to detect either advanced liver fibrosis or incident severe liver events. Advanced fibrosis was defined as an Enhanced Liver Fibrosis (ELF ) score >9.8 in the Health 2000 study (n = 6084), and incident liver events were ascertained from registry linkage in the combined FINRISK 2002-2012 and Health 2000 cohort (n = 26,957).
Depending on the cohort, 53%-60% of the population was considered at risk using the CLivD strategy (low-intermediate-high risk, excluding the minimal-risk category), compared to 30%-32% according to the other risk-stratification strategies. The CLivD captured 85%-91% of cases in the population with advanced liver fibrosis and 90% of incident severe liver events within 10 years from baseline. This compares to 33%-44% and 56%-67% captured by the other risk-stratification strategies, respectively. The 10-year cumulative incidence of liver events varied by risk-stratification strategy (1.0%-1.4%).
Compared to previously reported traditional risk factor-based strategies, use of the CLivD captured substantially more cases with advanced liver disease in the population and may be superior for targeting further fibrosis screening.
肝纤维化筛查建议用于高危人群,但“高危”的最佳定义仍有待确定。我们在基于人群的环境中比较了几种风险分层策略的表现。
数据来自芬兰基于人群的健康检查调查 Health 2000 和 FINRISK 2002-2012。将慢性肝病风险评分(CLivD)与以前发表的基于升高的肝酶、饮酒、糖尿病、脂肪肝指数、体重指数和/或代谢危险因素的风险分层策略进行比较,以评估其检测晚期肝纤维化或新发严重肝脏事件的能力。在 Health 2000 研究中,晚期纤维化定义为增强型肝纤维化(ELF)评分>9.8(n=6084),在 FINRISK 2002-2012 和 Health 2000 队列的联合注册链接中确定新发肝脏事件(n=26957)。
根据队列的不同,使用 CLivD 策略时,53%-60%的人群被认为存在风险(排除最低风险类别,低-中-高风险),而根据其他风险分层策略,这一比例为 30%-32%。CLivD 捕捉到人群中 85%-91%的晚期肝纤维化病例和 90%的 10 年内从基线开始的严重肝脏事件。相比之下,其他风险分层策略分别为 33%-44%和 56%-67%。各种风险分层策略的 10 年肝脏事件累积发生率不同(1.0%-1.4%)。
与以前报道的基于传统危险因素的策略相比,使用 CLivD 可以更准确地捕捉到人群中晚期肝病的更多病例,并且可能更适合靶向进一步的纤维化筛查。