Ability of noninvasive scoring systems to identify individuals in the population at risk for severe liver disease
Abstract
Background & aims Noninvasive scoring systems are used to identify persons with advanced liver fibrosis. We investigated the ability of scoring systems to identify individuals in the general population at risk for future liver-related events.Methods We collected data from the Swedish Apolipoprotein Mortality Risk cohort on persons 35 to 79 years old who had blood samples collected from 1985 through 1996. We collected APRI (n = 127,302), BARD (n = 75,303), FIB-4 (n = 126,941), Forns (n = 122,419), and the nonalcoholic fatty liver disease (NAFLD) fibrosis scores (NFS, n = 13,160). We ascertained incident cases of cirrhosis or complications by linking Swedish health data registers. Cox regression was used to estimate hazard ratios (HRs) for severe liver disease at 5, 10, and a maximum follow-up time of 27 years. The predictive ability of the scores was evaluated using area under the receiver operating characteristic (AUROC) curve and C-statistics analyses. Our specific aims were to investigate the predictive capabilities of scoring systems for fatal and nonfatal liver disease, determine which scoring system has the highest level of accuracy, and investigate the predictive abilities of the scoring systems in persons with a higher probability of NAFLD at baseline.Results A similar proportion of individuals evaluated by each scoring system developed cirrhosis or complications thereof (1.0%-1.4%). The incidence of any outcome was increased in intermediate- and high-risk groups compared with low-risk groups, with HRs at 10 years in the high-risk group ranging from 1.67 for the BARD score to 45.9 for the APRI score. The predictive abilities of all scoring systems decreased with time and were higher in men. All scoring systems were more accurate in persons with risk factors for NAFLD at baseline, with AUROCs reaching 0.83.Conclusions Higher scores from noninvasive scoring systems to evaluate fibrosis are associated with an increased risk of cirrhosis in a general population, but their predictive ability is modest. Performance was better when patients were followed for shorter time periods and in persons with a higher risk of NAFLD, with AUROC values reaching 0.83. New scoring systems are needed to evaluate risk of fibrosis in the general population and in primary care.
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A large population-based Swedish study reported that progression from a low or intermediate to a high-risk FIB-4 group was associated with an increased risk of developing severe liver disease (HR 7.99 and 8.64, respectively).
“A large population-based Swedish study in individuals with available FIB-4 at two time points within5 yearsreported thatprogression froma low orintermediate to a high-risk group was associated with an increased risk of developing severe liver disease (HR 7.99 and 8.64, respectively). 192”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [192]
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- Authors
- Hagström, H., Talbäck, M., Andreasson, A., Walldius, G., & Hammar, N.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Hagström, Hannes
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 158
- Issue
- 1
- Pages
- 200-214
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2975897277
- Cited by
- 182
- References
- 25
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 24 · 2023: 40 · 2022: 45 · 2021: 24 · 2020: 15 · 2019: 1
- FWCI
- 16.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gilead Sciences
- Intercept Pharmaceuticals
- AstraZeneca
- Stockholms Läns Landsting
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- liver fibrosis, liver cirrhosis, liver-related events, APRI, BARD score, FIB-4, NAFLD fibrosis score, non-alcoholic fatty liver disease, risk prediction, general population, prediction accuracy
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Humans, Liver Cirrhosis, Male, Middle Aged, Models, Biological, Predictive Value of Tests, Prognosis, Risk Factors, ROC Curve, Severity of Illness Index, Sweden, Incidence, Disease Progression, Risk Assessment, Non-alcoholic Fatty Liver Disease
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