LiverRisk score: An accurate, cost-effective tool to predict fibrosis, liver-related, and diabetes-related mortality in the general population.

IF 12.8 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Med Pub Date : 2024-06-14 Epub Date: 2024-03-29 DOI:10.1016/j.medj.2024.03.003

Shanghao Liu, Xiaohan Chen, Xuanwei Jiang, Xiaochun Yin, Ginenus Fekadu, Chuan Liu, Yan He, Huihui Chen, Wenjing Ni, Ruiying Wang, Qing-Lei Zeng, Yuping Chen, Ling Yang, Ruihua Shi, Sheng-Hong Ju, Jie Shen, Jingli Gao, Linhua Zhao, Wai-Kit Ming, Victor W Zhong, Gao-Jun Teng, Xiaolong Qi

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引用次数: 0

Abstract

Background: Noninvasive and early assessment of liver fibrosis is of great significance and is challenging. We aimed to evaluate the predictive performance and cost-effectiveness of the LiverRisk score for liver fibrosis and liver-related and diabetes-related mortality in the general population.

Methods: The general population from the NHANES 2017-March 2020, NHANES 1999-2018, and UK Biobank 2006-2010 were included in the cross-sectional cohort (n = 3,770), along with the NHANES follow-up cohort (n = 25,317) and the UK Biobank follow-up cohort (n = 17,259). The cost-effectiveness analysis was performed using TreeAge Pro software. Liver stiffness measurements ≥10 kPa were defined as compensated advanced chronic liver disease (cACLD).

Findings: Compared to conventional scores, the LiverRisk score had significantly better accuracy and calibration in predicting liver fibrosis, with an area under the receiver operating characteristic curve (AUC) of 0.76 (0.72-0.79) for cACLD. According to the updated thresholds of LiverRisk score (6 and 10), we reclassified the population into three groups: low, medium, and high risk. The AUCs of LiverRisk score for predicting liver-related and diabetes-related mortality at 5, 10, and 15 years were all above 0.8, with better performance than the Fibrosis-4 score. Furthermore, compared to the low-risk group, the medium-risk and high-risk groups in the two follow-up cohorts had a significantly higher risk of liver-related and diabetes-related mortality. Finally, the cost-effectiveness analysis showed that the incremental cost-effectiveness ratio for LiverRisk score compared to FIB-4 was USD $18,170 per additional quality-adjusted life-year (QALY) gained, below the willingness-to-pay threshold of $50,000/QALY.

Conclusions: The LiverRisk score is an accurate, cost-effective tool to predict liver fibrosis and liver-related and diabetes-related mortality in the general population.

Funding: The National Natural Science Foundation of China (nos. 82330060, 92059202, and 92359304); the Key Research and Development Program of Jiangsu Province (BE2023767a); the Fundamental Research Fund of Southeast University (3290002303A2); Changjiang Scholars Talent Cultivation Project of Zhongda Hospital of Southeast University (2023YJXYYRCPY03); and the Research Personnel Cultivation Program of Zhongda Hospital Southeast University (CZXM-GSP-RC125).

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肝脏风险评分：预测普通人群肝纤维化、肝脏相关和糖尿病相关死亡率的准确、经济高效的工具。

背景：肝纤维化的无创早期评估意义重大且具有挑战性。我们旨在评估 LiverRisk 评分对普通人群肝纤维化以及肝脏相关和糖尿病相关死亡率的预测性能和成本效益：横断面队列（n = 3,770）、NHANES 随访队列（n = 25,317）和英国生物库随访队列（n = 17,259）中纳入了 2017 年至 2020 年 3 月 NHANES、1999 年至 2018 年 NHANES 和 2006 年至 2010 年英国生物库的普通人群。成本效益分析使用 TreeAge Pro 软件进行。肝脏僵硬度测量值≥10 kPa被定义为代偿性晚期慢性肝病（cACLD）：结果：与传统评分相比，LiverRisk评分在预测肝纤维化方面的准确性和校准性明显更佳，cACLD的接收者工作特征曲线下面积（AUC）为0.76（0.72-0.79）。根据最新的肝脏风险评分阈值（6 分和 10 分），我们将人群重新分为三组：低风险、中风险和高风险。肝脏风险评分预测5年、10年和15年肝脏相关死亡率和糖尿病相关死亡率的AUC均高于0.8，优于纤维化-4评分。此外，与低风险组相比，两个随访队列中的中风险组和高风险组发生肝脏相关和糖尿病相关死亡的风险明显更高。最后，成本效益分析表明，与FIB-4相比，LiverRisk评分每增加一个质量调整生命年（QALY）的增量成本效益比为18,170美元，低于50,000美元/QALY的支付意愿阈值：肝脏风险评分是预测普通人群肝纤维化、肝脏相关死亡率和糖尿病相关死亡率的一种准确、经济有效的工具：国家自然科学基金（82330060、92059202和92359304）；江苏省重点研发计划（BE2023767a）；东南大学基础研究基金（3290002303A2）；东南大学附属中大医院长江学者人才培养项目（2023YJXYYRCPY03）；东南大学附属中大医院科研人才培养项目（CZXM-GSP-RC125）。

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来源期刊

Med MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

17.70

自引率

0.60%

发文量

102

期刊介绍： Med is a flagship medical journal published monthly by Cell Press, the global publisher of trusted and authoritative science journals including Cell, Cancer Cell, and Cell Reports Medicine. Our mission is to advance clinical research and practice by providing a communication forum for the publication of clinical trial results, innovative observations from longitudinal cohorts, and pioneering discoveries about disease mechanisms. The journal also encourages thought-leadership discussions among biomedical researchers, physicians, and other health scientists and stakeholders. Our goal is to improve health worldwide sustainably and ethically. Med publishes rigorously vetted original research and cutting-edge review and perspective articles on critical health issues globally and regionally. Our research section covers clinical case reports, first-in-human studies, large-scale clinical trials, population-based studies, as well as translational research work with the potential to change the course of medical research and improve clinical practice.