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Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study
Authors
Alina Allen
Marifé Alvarez
+134 more
Peter Andersen
Paolo Angeli
Alba Ardèvol
Anita Arslanow
Luca Beggiato
Zahia Ben Abdesselam
Lucy Bennett
Eva Bonfill
Bajiha Boutouria
Alessandra Brocca
M. Teresa Broquetas
Llorenç Caballeria
Valeria Calvino
Judith Camacho
Aura Capdevila
Marta Carol
Laurent Castera
Marta Cervera
Fernando Cucchietti
Anna de Fuentes
Rob de Knegt
Robert J de Knegt
Harry J de Koning
Sonke Detlefsen
Sönke Detlefsen
Alba Diaz
José Diéguez Bande
Vanessa Esnault
Carmen Expósito
Núria Fabrellas
Josep Lluis Falcó
Rosa Fernández
Céline Fournier
Matilde Fuentes
Peter Galle
Montserrat Garcia-Retortillo
Edgar García
Montserrat García-Retortillo
Esther Garrido
Pere Ginès
Rosa Gordillo Medina
Jordi Gratacós-Ginès
Isabel Graupera
Ivica Grgurevic
Indra Neil Guha
Eva Guix
Johanne Kragh Hansen
Rebecca Harris
Rubén Hernáez
Elena Hernández Boluda
Rosario Hernández
Rosario Hernández-Ibañez
Jordi Hoyo
Arfan Ikram
Simone Incicco
Mads Israelsen
Marta Juan
Adrià Juanola
Ralf Kaiser
Patrick S Kamath
Tom H Karlsen
Maria Kjærgaard
Marko Korenjak
Aleksander Krag
Marcin Krawczyk
Philippe Laboulaye
Irina Lambert
Frank Lammert
Simon Langkjær Sørensen
Cristina Laserna-Jiménez
Sonia Lazaro Pi
Elsa Ledain
Vincent Levy
Katrine Prier Lindvig
Anne Llorca
Vanessa Londoño
Guirec Loyer
Ann T Ma
Ann T. Ma
Anita Madir
Michael Manns
Denise Marshall
Andrea Martini
M. Lluïsa Martí
Ricard Martínez Sala
Alba Martínez
Sara Martínez
Roser Masa-Font
Rosa M Morillas
Laura Muñoz
Jane Møller Jensen
Ruth Nadal
Laura Napoleone
J M Navarrete
JM Navarrete
Phillip N Newsome
Vibeke Nielsen
Guillem Pera
Juan M Pericàs
Juan Manuel Pericás-Pulido
Salvatore Piano
Judit Pich
Judith Pich
Elisa Pose
Judit Presas Escobet
Martina Pérez
Mathias Reichert
Matthias Reichert
Carlota Riba
Dominique Roulot
Ana Belén Rubio
Jörn Schattenberg
Jörn M Schattenberg
Feliu Serra-Burriel
Miquel Serra-Burriel
Louise Skovborg Just
Milan Sonneveld
Anna Soria
Christiane Stern
Patricia Such
Maria Sánchez-Morata
Maja Thiele
Marta Tonon
Pere Toran
Antoni Torrejón
Emmanuel A Tsochatzis
Emmanuel A Tsochatztis
Laurens van Kleef
Paulien van Wijngaarden
Vanessa Velázquez
Ana Viu
Susanne Nicole Weber
Tracey Wildsmith
Vincent Wai-Sun Wong
Publication date
16 September 2023
Publisher
Elsevier
Doi
Abstract
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. 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). 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. 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. None. [Abstract copyright: Copyright © 2023 Elsevier Ltd. All rights reserved.
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Last time updated on 02/10/2023