Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Author
Serra-Burriel, MiquelJuanola, Adrià
Serra-Burriel, Feliu
Thiele, Maja
Graupera, Isabel
Pose, Elisa
Pera, Guillem
Grgurevic, Ivica
Caballeria, Llorenç
Piano, Salvatore
van Kleef, Laurens
Reichert, Mathias
Roulot, Dominique
Pericàs, Juan M
Schattenberg, Jörn M
Tsochatztis, Emmanuel A
Guha, Indra Neil
Garcia-Retortillo, Montserrat
Hernández, Rosario
Hoyo, Jordi
Fuentes, Matilde
Expósito, Carmen
Martínez, Alba
Such, Patricia
Madir, Anita
Detlefsen, Sönke
Tonon, Marta
Martini, Andrea
Ma, Ann T
Pich, Judith
Bonfill, Eva
Juan, Marta
Soria, Anna
Carol, Marta
Gratacós-Ginès, Jordi
Morillas, Rosa M
Toran, Pere
Navarrete, J M
Torrejón, Antoni
Fournier, Céline
Llorca, Anne
Arslanow, Anita
de Koning, Harry J
Cucchietti, Fernando
Manns, Michael
Newsome, Phillip N
Hernáez, Rubén
Allen, Alina
Angeli, Paolo
de Knegt, Robert J
Karlsen, Tom H
Galle, Peter
Wong, Vincent Wai-Sun
Fabrellas, Núria
Castera, Laurent
Krag, Aleksander
Lammert, Frank
Kamath, Patrick S
Ginès, Pere
Publication date
2023-08-09
Metadata
Show full item recordAbstract
Background: Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. Methods: We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). Findings: We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78-0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61-0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347-641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88-0·91) versus 0.84 (0·82-0·86) for FIB-4. Interpretation: The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care.Citation
Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, Pera G, Grgurevic I, Caballeria L, Piano S, van Kleef L, Reichert M, Roulot D, Pericàs JM, Schattenberg JM, Tsochatztis EA, Guha IN, Garcia-Retortillo M, Hernández R, Hoyo J, Fuentes M, Expósito C, Martínez A, Such P, Madir A, Detlefsen S, Tonon M, Martini A, Ma AT, Pich J, Bonfill E, Juan M, Soria A, Carol M, Gratacós-Ginès J, Morillas RM, Toran P, Navarrete JM, Torrejón A, Fournier C, Llorca A, Arslanow A, de Koning HJ, Cucchietti F, Manns M, Newsome PN, Hernáez R, Allen A, Angeli P, de Knegt RJ, Karlsen TH, Galle P, Wong VW, Fabrellas N, Castera L, Krag A, Lammert F, Kamath PS, Ginès P; LiverScreen Consortium Investigators. Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study. Lancet. 2023 Aug 9:S0140-6736(23)01174-1. doi: 10.1016/S0140-6736(23)01174-1. Epub ahead of print. PMID: 37572680.Type
ArticlePMID
37572680Journal
The LancetPublisher
Elsevierae974a485f413a2113503eed53cd6c53
10.1016/S0140-6736(23)01174-1