Kim W Ray, Mannalithara Ajitha, Charu Vivek, Chung Nakia, Kwong Allison, Kwo Paul Y, Torok Natalie J, Asch Steven M, Kim Sun H
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Am J Gastroenterol. 2025 Jan 3. doi: 10.14309/ajg.0000000000003268.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important public health threat, potentially leading to chronic liver disease and liver cancer. Current guidelines recommend using the Fibrosis-4 score for initial identification of subjects at risk of future complications. We formulate a novel population screening strategy based on the Steatosis-Associated Fibrosis Estimator (SAFE) score, recently developed for MASLD risk stratification in primary care.
We interrogated the National Health and Nutrition Examination Survey data, 2017-20, in which a sample of subjects representative of US civilian population underwent vibration-controlled transient elastography (VCTE). The current guideline and a new, SAFE-based proposal were applied to these data to project the number of subjects to be diagnosed with liver fibrosis gauged by liver stiffness measurement (LSM), including significant (LSM ≥8 kPa) and advanced (LSM ≥12 kPa) fibrosis, as well as the number of VCTEs to be performed.
In the survey data, 2,691 subjects, projecting to 75.8 million US adults, were found to have MASLD, of whom 11% had LSM 8-12 kPa and 6% LSM ≥12 kPa. When the current guideline was applied, 18.1 million VCTEs would be needed to diagnose 3.5 million subjects with LSM ≥8 kPa and 1.7 million subjects with LSM ≥12 kPa. In comparison, a new approach based on the SAFE score would detect 4.9 million with LSM ≥8 kPa and 2.5 million subjects with LSM ≥12 kPa (37% and 45% improvement over the current guideline, respectively), while requiring 5.0 million fewer VCTEs (28% reduction).
The proposed population risk stratification approach using the SAFE score is simpler and substantially more effective, yielding more subjects with liver fibrosis while requiring less resources compared with the currently recommended algorithm.
代谢功能障碍相关脂肪性肝病（MASLD）是一项重大的公共卫生威胁，有可能导致慢性肝病和肝癌。当前指南建议使用Fibrosis-4评分来初步识别有未来并发症风险的受试者。我们基于最近为基层医疗中MASLD风险分层而开发的脂肪变性相关纤维化估计值（SAFE）评分，制定了一种新的人群筛查策略。
我们查阅了2017 - 2020年美国国家健康与营养检查调查数据，其中一组代表美国平民人口的受试者样本接受了振动控制瞬时弹性成像（VCTE）检查。将当前指南和一项基于SAFE评分的新提议应用于这些数据，以预测通过肝脏硬度测量（LSM）诊断为肝纤维化的受试者数量，包括显著肝纤维化（LSM≥8 kPa）和进展期肝纤维化（LSM≥12 kPa），以及需要进行的VCTE检查数量。
在调查数据中，发现2691名受试者患有MASLD，预计美国有7580万成年人患有此病，其中11%的受试者LSM为8 - 12 kPa，6%的受试者LSM≥12 kPa。应用当前指南时，需要进行1810万次VCTE检查，以诊断出350万名LSM≥8 kPa的受试者和170万名LSM≥12 kPa的受试者。相比之下，基于SAFE评分的新方法将检测出490万名LSM≥8 kPa的受试者和250万名LSM≥12 kPa的受试者（分别比当前指南提高37%和45%），同时所需的VCTE检查少500万次（减少28%）。
提议的使用SAFE评分的人群风险分层方法更简单且显著更有效，与当前推荐的算法相比，能发现更多肝纤维化受试者，同时所需资源更少。
