Steatotic liver disease risk scores compared for predicting cirrhosis

For patients with steatotic liver disease (SLD), the steatosis-associated fibrosis estimator (SAFE) score demonstrated the greatest net benefit for predicting cirrhosis, according to a study published online Sept. 21 in JAMA Internal Medicine.

Catherine Mezzacappa, M.D., Ph.D., M.P.H., from the Yale School of Medicine in New Haven, Connecticut, and colleagues compared the clinical utility of SLD risk scores for predicting cirrhosis and hepatocellular carcinoma (HCC) in patients with noncirrhotic SLD. The cohort study used data from adults with imaging-confirmed SLD in the national U.S. Veterans Affairs health system. Nine clinical risk scores were evaluated for their ability to predict cirrhosis or HCC within 10 years.

The analysis included 853,131 patients, of whom 3.96% developed cirrhosis and 0.35% developed HCC within 10 years. The fibrosis-4 index (FIB-4), the aspartate aminotransferase-to-platelet ratio and SAFE scores showed the greatest discrimination of cirrhosis risk; the SAFE, Tate and FIB-4 scores showed the greatest discrimination of HCC risk.

The SAFE score had the greatest net benefit for predicting cirrhosis. A score of 29.5 corresponded to a 10-year cirrhosis risk of 2.5% and a net benefit of 0.019 (1.9 additional individuals who develop cirrhosis per 100 classified as at risk). The SAFE score had a net benefit of 0.0016 at a 0.25% 10-year risk for HCC.

“This comparative validation study highlights the importance of assessing test performance at relevant thresholds for clinical practice,” the authors write.

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