The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Hepatol Commun. 2024 Aug 26;8(9). doi: 10.1097/HC9.0000000000000515. eCollection 2024 Sep 1.
Liver fibrosis is a critical public health concern, necessitating early detection to prevent progression. This study evaluates the recently developed LiverRisk score and steatosis-associated Fibrosis Estimator (SAFE) score against established indices for prognostication and/or fibrosis prediction in 4diverse cohorts, including participants with metabolic dysfunction-associated steatotic liver disease (MASLD).
We used data from the Mount Sinai Data Warehouse (32,828 participants without liver disease diagnoses), the Mount Sinai MASLD/MASH Longitudinal Registry (422 participants with MASLD), and National Health and Nutrition Examination Survey 2017-2020 (4133 participants representing the general population) to compare LiverRisk score, FIB-4 index, APRI, and SAFE score. Analyses included Cox proportional hazards regressions, Kaplan-Meier estimates, and classification metrics to evaluate performance in prognostication and fibrosis prediction.
In Mount Sinai Data Warehouse, LiverRisk score was significantly associated with future liver-related outcomes but did not significantly outperform FIB-4 or APRI for predicting any of the outcomes. In the general population, LiverRisk score and SAFE score outperformed FIB-4 and APRI in identifying fibrosis, but LiverRisk score underperformed among participants who were non-White or had type 2 diabetes. Among participants with MASLD, SAFE score outperformed FIB-4 and APRI in 1 of 2 cohorts, but there were generally few significant performance differences between all 4 scores.
LiverRisk score does not consistently outperform existing predictors in diverse populations, and further validation is needed before adoption in settings with significant differences from the original derivation cohorts. It remains necessary to replicate the ability of these scores to predict liver-specific mortality, as well as to develop diagnostic tools for liver fibrosis that are accessible and substantially better than current scores, especially among patients with MASLD and other chronic liver conditions.
肝纤维化是一个严重的公共卫生问题，需要早期检测以防止其进展。本研究评估了最近开发的 LiverRisk 评分和脂肪变性相关纤维化评估器（SAFE）评分在 4 个不同队列中的预测价值，这些队列包括代谢功能障碍相关脂肪性肝病（MASLD）患者。
我们使用了来自西奈山数据仓库（32828 名无肝脏疾病诊断的参与者）、西奈山 MASLD/MASH 纵向登记处（422 名 MASLD 患者）和 2017-2020 年全国健康和营养调查（4133 名代表一般人群的参与者）的数据来比较 LiverRisk 评分、FIB-4 指数、APRI 和 SAFE 评分。分析包括 Cox 比例风险回归、Kaplan-Meier 估计和分类指标，以评估在预后和纤维化预测方面的表现。
在西奈山数据仓库中，LiverRisk 评分与未来的肝脏相关结局显著相关，但在预测任何结局方面，并未显著优于 FIB-4 或 APRI。在一般人群中，LiverRisk 评分和 SAFE 评分在识别纤维化方面优于 FIB-4 和 APRI，但在非白人或患有 2 型糖尿病的参与者中表现不佳。在 MASLD 患者中，SAFE 评分在 2 个队列中的 1 个队列中优于 FIB-4 和 APRI，但在所有 4 个评分之间，一般差异不大。
在不同人群中，LiverRisk 评分并不总是优于现有的预测因子，在采用与原始推导队列有显著差异的设置之前，还需要进一步验证。有必要复制这些评分预测肝特异性死亡率的能力，并开发出可用于肝纤维化的诊断工具，这些工具不仅易于使用，而且比目前的评分显著更好，特别是在 MASLD 和其他慢性肝病患者中。
