Prevalence of Fibrosis and Applicability of Lab-based Noninvasive Tests From Primary to Tertiary Care.

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-09-16 DOI:10.1016/j.cgh.2025.09.008

Georg Semmler, Paul Thöne, Jan Embacher, Philipp Hruska, Lucie Simonis, Katharina Stopfer, Laurenz Fritz, Fiona Köck, Lorenz Balcar, Benedikt S Hofer, Bernhard Wernly, Sophie Gensluckner, Michael Strasser, Andreas Völkerer, Katrine Lindvig, Maja Thiele, Sarah Wernly, Robert Winker, Thomas Reiberger, Mattias Mandorfer, Michael Trauner, Christian Datz, Thomas-Mathias Scherzer, Elmar Aigner

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引用次数: 0

Abstract

Background & aims: Knowing the prevalence of fibrosis, the accuracy of noninvasive tests, and their applicability in referral strategies of individuals screened or surveilled for steatotic liver disease is crucial for individual and policy decision making.

Methods: Five cohorts spanning primary to tertiary care between 2016 and 2024 were retrospectively included: individuals from the general population (colonoscopy screening, n = 1197, cohort I; primary care); at-risk individuals with metabolic dysfunction (overweight n = 1333, cohort II; prediabetes, n = 996, cohort III; secondary care); and subjects referred to hepatology clinics (n = 2397/n = 2598, cohort IV/V; tertiary care).

Results: Mean controlled attenuation parameter was 262 to 294 dB/m, and 41% to 64% showed hepatic steatosis. Suspected fibrosis (liver stiffness measurement [LSM] ≥8 kPa) was found in 6.4% of cohort I, 7.3%/6.8% of cohort II/III, and 21%/30% of cohort IV/V, whereas advanced fibrosis (≥12 kPa) was rare (1.2% in cohort I, 1.4%/0.8% in cohorts II/III, and 12%/17% in cohorts IV/V, respectively). The prevalence of fibrosis was especially high in subjects with obesity or diabetes, but not in overweight or prediabetes. Sensitivity of Fibrosis-4 index ≥1.3 for liver stiffness measurement ≥8 kPa was low in primary and secondary care (33%-44%) with simultaneously low positive predictive value (8.3%-12%), and overall low accuracy (area under the precision recall curve [AUPRC], 0.09-0.15). LiverPRO (AUPRC, 0.12-0.24) and LiverRisk score (AUPRC, 0.13-0.24) were numerically more accurate, with LiverPRO being the most sensitive and LiverRisk score the most specific first-line test. In tertiary care, LiverPRO was comparatively accurate, but more sensitive than Fibrosis-4 index.

Conclusion: Prevalence of fibrosis in contemporary patients with steatotic liver disease was ∼7% in primary/secondary care, being especially pronounced in individuals with diabetes or obesity. LiverPRO and LiverRisk score optimize referral pathways.

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从初级保健到三级保健的纤维化患病率和基于实验室的无创检查的适用性

背景和目的：了解纤维化的患病率，非侵入性检查（nit）的准确性及其在筛查或监测脂肪变性肝病（SLD）个体转诊策略中的适用性对于个人和政策决策至关重要。方法：回顾性纳入2016-2024年间跨越初级保健到三级保健的五个队列：来自普通人群的个体（结肠镜检查，n=1197，队列1；初级保健）；有代谢功能障碍的高危个体（超重n=1333，队列II；前驱糖尿病n=996，队列III；二级护理）；和转介到肝病诊所的受试者（n=2397/n=2598，队列IV/V；三级保健）。结果：平均CAP为262 ~ 294db /m， 41 ~ 64%表现为肝脂肪变性。队列I中6.4%、队列II/III中7.3/6.8%、队列IV/V中21/30%存在疑似纤维化（LSM≥8kPa），而晚期纤维化（≥12kPa）罕见（队列I中为1.2%、队列II/III中为1.4%/0.8%、队列IV/V中为12%/17%）。肥胖或糖尿病患者的纤维化患病率特别高，但超重或前驱糖尿病患者的患病率不高。对于LSM≥8kPa， FIB-4≥1.3的敏感性较低（33-44%），同时PPV较低（8.3-12%），总体准确度较低（AUPRC 0.09-0.15）。LiverPRO （AUPRC: 0.12-0.24）和LiverRisk评分（0.13-0.24）在数值上更为准确，其中LiverPRO是最敏感的，而LiverRisk评分是最具体的一线检测。在三级保健中，LiverPRO相对准确，但比FIB-4更敏感。结论：在初级/二级护理中，当代SLD患者的纤维化患病率约为7%，在糖尿病或肥胖患者中尤为明显。LiverPRO和LiverRisk评分优化转诊途径。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.