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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: The steatosis-associated fibrosis estimator score demonstrated the most benefit for predicting incident cirrhosis. Available risk scores could not reliably predict 10-year risk for HCC. Among nine available risk scores for steatotic liver disease, none were able to reliably predict elevated risk for hepatocellular carcinoma and one appeared most beneficial for cirrhosis risk, analysis showed. \u201cSteatotic liver disease is very common; it affects about a third of American adults,\u201d Catherine Mezzacappa, MD, PhD, MPH, assistant professor of medicine at Yale School of Medicine and associate director of population health at Yale Liver Center, told Healio. \u201cHowever, the vast majority of these individuals will not develop advanced liver diseases.
\u201cThe goal of this study was to assess whether available risk scores can identify which patients are most likely to develop cirrhosis or hepatocellular carcinoma \u2014 the most common form of liver cancer \u2014 and whether these scores can help inform screening for these advanced liver diseases,\u201d she added. Mezzacappa and colleagues analyzed data from 853,131 patients (median age, 61 years; 92.7% men; median BMI, 31.3 kg\/m2) with imaging-verified steatotic liver disease in the U.S. Veterans Affairs health system, of whom nearly a third (32.3%) also had diabetes. Data were collected between 2008 and 2020. Over median follow-up of 8.5 years, 3.96% of patients developed cirrhosis and 0.35% developed HCC. The researchers observed that Fibrosis-4 index, aspartate aminotransferase-to-platelet ratio and steatosis-associated fibrosis estimator (SAFE) scores were associated with the greatest predictive value for cirrhosis risk, with SAFE outperforming the others in predictive ability at higher score thresholds. For every 100 high-risk patients, the SAFE score identified an additional 1.9 individuals who would develop cirrhosis within 10 years. Specifically, a SAFE score of 29.5 was associated with a 10-year cirrhosis risk of 2.5%. As most patients in the Veterans Affairs health system are men, the investigators performed a second analysis including only women. \u201cA higher SAFE score of 65.4 correlated to the same risk of cirrhosis among women with steatotic liver disease,\u201d Mezzacappa said. Analysis also showed that SAFE, Tate and FIB-4 scores were most accurate at predicting 10-year HCC risk, but \u201cnone identified patients with high enough risk of hepatocellular carcinoma to initiate screening based on current guidelines,\u201d Mezzacappa said. \u201cThis gives us a benchmark of how far we still need to go to identify patients with noncirrhotic steatotic liver disease at the highest risk of hepatocellular carcinoma who may benefit from screening,\u201d she added. None of the other risk scores evaluated \u2014 albumin-bilirubin; age-male-albumin-bilirubin-platelet; BMI, age, alanine aminotransferase-to-aspartate aminotransferase ratio and diabetes, or BARD; and nonalcoholic fatty liver disease fibrosis \u2014 had significant predictive value for cirrhosis or HCC. The researchers acknowledged study limitations, including the exclusion of six risk scores due to lack of data. Additional research is needed to explore these additional risk prediction modalities, including several that rely on gamma-glutamyl transferase (GGT) measurement, according to Mezzacappa. \u201cMost practice settings in the United States don\u2019t include a GGT on a routine liver panel, though, and so GGT is measured in a small minority of patients, typically to follow up other abnormal liver testing,\u201d she said. \u201cStrong evidence\u201d indicates GGT may have predictive value for liver diseases, she added. \u201cFor patients with steatotic liver disease who don\u2019t already have advanced liver disease, risk scores can help providers and patients understand their risk for developing cirrhosis in the future,\u201d Mezzacappa told Healio. \u201cTargeting repeated testing to identify cirrhosis using a risk score, such as the SAFE score, can improve the balance of case detection to the harms and costs of repeated assessments.\u201d For more information: Catherine Mezzacappa, MD, PhD, MPH, can be reached at gastroenterology@healio.com. Published by: Ask a clinical question and tap into Healio AI’s knowledge base.
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