Risk Score May Help Inform Screening Decisions for Patients with Steatotic Liver Disease

Steatotic liver disease, commonly known as fatty liver disease, affects roughly one-third of U.S. adults. While the condition rarely progresses to advanced liver disease, it remains a leading risk factor for cirrhosis and hepatocellular carcinoma, the most common form of liver cancer.

The difference between how common the disease is and how often it progresses creates a challenge for physicians: deciding which patients need closer monitoring.

“This motivated us to investigate whether we could use the tools that we already have to predict which individuals with steatotic liver disease may be at risk in the future,” says Catherine Mezzacappa, MD, PhD, assistant professor of medicine (digestive diseases) at Yale School of Medicine. “Who do we need to keep a close eye on? Who needs repeat testing?”

In their recent study, published in JAMA Internal Medicine, Mezzacappa and colleagues compared nine clinical risk scores for assessing patients with steatotic liver disease. The researchers analyzed the health records of more than 850,000 individuals with steatotic liver disease in the U.S. Veterans Affairs health system who had not been diagnosed with cirrhosis or hepatocellular carcinoma.

The researchers found that FIB-4, APRI, and the Steatotic-Associated Fibrosis Estimator (SAFE) were among the best at distinguishing patients who would develop cirrhosis within 10 years. However, when the researchers considered both predictive accuracy and the usefulness of each score for clinical decision making, SAFE provided the greatest benefit.

The findings were less encouraging for predicting liver cancer. The study found that the available risk scores offered minimal clinical benefit for determining which patients without cirrhosis should undergo screening for hepatocellular carcinoma.

Screening for hepatocellular carcinoma is currently recommended for patients with both steatotic liver disease and cirrhosis because the average risk of hepatocellular carcinoma in earlier stages of steatotic liver disease is low. However, approximately one-third of hepatocellular carcinoma cases associated with steatotic liver disease arise in patients without pre-existing cirrhosis.

While the findings highlight the need for better tools to predict liver cancer risk, Mezzacappa emphasizes that serious liver complications remain uncommon among the millions of people with steatotic liver disease.

“We want people to be aware of these risks and understand that they’re important, but most people will never progress to advanced liver disease,” she says. “The key challenge remains accurately identifying the minority of patients with steatotic liver disease who are at highest risk and warrant targeted interventions.”

Other Yale authors of the study include Janet Tate, ScD, MPH; Tamar Taddei, MD; and Amy Justice, MD, PhD.

Digestive Diseases, one of 10 sections in the Yale Department of Internal Medicine, is committed to advancing gastrointestinal and liver health through exceptional patient care, scientific discovery, and education in a collaborative environment. To learn more, visit Digestive Diseases.