Optimal Population Screening Strategies for Liver Fibrosis Associated With Metabolic Dysfunction-Associated Steatotic...

Area of Science:

• Hepatology
• Public Health
• Diagnostic Strategies

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a significant public health risk, potentially progressing to chronic liver disease and cancer.
• Current guidelines utilize the Fibrosis-4 score for initial risk assessment of MASLD complications.
• There is a need for improved risk stratification strategies in primary care for MASLD.

Purpose of the Study:

• To evaluate a novel population screening strategy for MASLD using the Steatosis-Associated Fibrosis Estimator (SAFE) score.
• To compare the effectiveness and resource utilization of the SAFE score-based strategy against the current guideline for identifying liver fibrosis.

Main Methods:

• Utilized National Health and Nutrition Examination Survey (NHANES) data (2017-20) including vibration-controlled transient elastography (VCTE) measurements.
• Applied both the current guideline (Fibrosis-4 score) and the proposed SAFE score strategy to project diagnoses of significant (LSM ≥8 kPa) and advanced (LSM ≥12 kPa) liver fibrosis.
• Calculated the number of VCTE procedures required for each strategy.

Main Results:

• MASLD affects an estimated 75.8 million US adults, with 11% having significant and 6% advanced fibrosis.
• The current guideline necessitates 18.1 million VCTEs to diagnose 3.5 million with significant and 1.7 million with advanced fibrosis.
• The SAFE score strategy identified 4.9 million with significant and 2.5 million with advanced fibrosis, a 37% and 45% improvement, respectively, while reducing VCTE procedures by 28% (5.0 million fewer).

Conclusions:

• The SAFE score-based population risk stratification approach for MASLD is simpler and more effective than the current algorithm.
• This new strategy identifies a greater number of individuals with liver fibrosis.
• The SAFE score approach requires fewer resources, specifically reducing the number of VCTE tests needed.