Validated Early Detection Metrics Reduce the Population Requiring Liver Fibrosis Screening
Abstract
BACKGROUND & AIMS: Current guideline-defined indicators for fibrosis screening identify a large proportion of the general population, burdening health care resources. We aimed to evaluate and refine indicators for fibrosis screening. METHODS: without excessive alcohol use. We obtained the weighted proportions of individuals across stratified screening indicators and targeted only subgroups with ≥10% liver stiffness measurement (LSM ≥8 kPa) risk for screening. These refined criteria were validated and linked with liver-related events in 4 general-population cohorts. RESULTS: The derivation cohort included 5904 adults (8.9% LSM ≥8 kPa). Current guidelines identified 60%-76% as screening-eligible, yielding an LSM ≥8 kPa prevalence of 11%-14% among those screening eligible and 2% among those not eligible. Our refined strategy targeted 22% for screening, increasing prevalence to 28% among those screening-eligible, while maintaining low prevalence (4%) in those not eligible. In the pooled validation cohort (n = 13,295; 7.0% LSM ≥8 kPa), 14% met the refined criteria. Results remained consistent across thresholds: LSM ≥8, ≥10, and ≥12 kPa prevalence among screening-eligible individuals was 22%, 13%, and 8%, respectively, and 4%, 2%, and 1% among those not eligible. In the UK Biobank (n = 282,852), individuals meeting the refined criteria had an approximately 6-fold higher 10-year risk of incident cirrhosis (0.99% vs 0.18%) and liver-related death (0.40% vs 0.07%). CONCLUSIONS: Current recommendations target 60%-76% of adults for fibrosis screening. Our refined strategy reduced this to 10%-22%, achieving significantly higher disease prevalence among those eligible for screening, while maintaining a very low risk of increased LSM or liver-related events in those not eligible for screening.
Authors 17
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Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: l.vankleef@erasmusmc.nl
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Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Affiliation as printed
Department of Gastroenterology, Intensive Care and Metabolic Diseases, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
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Institut Universitari d'Investigació en Atenció Primària Jordi Gol
Affiliation as printed
Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Barcelona, Spain
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Institut Universitari d'Investigació en Atenció Primària Jordi Gol
Affiliation as printed
Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Mataró, Barcelona, Spain
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Affiliation as printed
Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany; Medical Faculty, Saarland University, Saarbrücken, Germany
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Affiliation as printed
Department of Gastroenterology, Intensive Care and Metabolic Diseases, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
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Amsterdam University Medical Centers
Affiliation as printed
Department of Vascular Internal Medicine, Amsterdam Medical Center, Amsterdam, The Netherlands
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Erasmus MC · Sint Franciscus Gasthuis · Erasmus University Rotterdam
Affiliation as printed
Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands; Department of Internal Medicine and Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
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University Health Network · Toronto General Hospital · Erasmus MC
Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario Canada
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Affiliation as printed
Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany; Medical Faculty, Saarland University, Saarbrücken, Germany
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Hospital Clínic de Barcelona · Universitat de Barcelona
Affiliation as printed
Liver Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
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University of Antwerp · Antwerp University Hospital
Affiliation as printed
InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
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Affiliation as printed
The Global Nonalcoholic Steatohepatitis Council, Washington, District of Columbia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
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University of Southern Denmark · Odense University Hospital
Affiliation as printed
Department of Gastroenterology and Hepatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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