Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;57(4):418-425.
doi: 10.1111/apt.17374. Epub 2022 Dec 25.

Improved prediction of 10-year risk of severe liver disease in the general population using commonly available biomarkers

Hannes Hagström  1   2 , Jacinth Yan  3 , Mats Talbäck  4 , Anna Andreasson  5   6 , Göran Walldius  4 , Matteo Bottai  3 , Niklas Hammar  4
Affiliations

Improved prediction of 10-year risk of severe liver disease in the general population using commonly available biomarkers

Hannes Hagström et al. Aliment Pharmacol Ther. 2023 Feb.

Abstract

Background: Estimating the risk for cirrhosis in the general population is complex. Existing prediction tools are in general unsatisfactory.

Aims: To explore if using commonly available biomarkers can improve the commonly used FIB-4 score in the identification of subgroups at risk of cirrhosis.

Methods: We used laboratory and clinical data on 126,925 individuals aged 35-79 years in Stockholm, Sweden, undergoing health examinations from 1985 to 1996. We used Swedish nationwide registries to ascertain 10-year cumulative incidence of severe liver disease, a composite of diagnoses corresponding to cirrhosis and its complications. We considered combinations of biomarkers associated with severe liver disease to identify subgroups with different risk profiles.

Results: During an average follow-up of 9.3 years, we ascertained 630 incident cases of severe liver disease (0.5%). Age, the FIB-4 score, diabetes or impaired glucose and gamma-glutamyl transferase (gGT) were the most relevant characteristics for classifying risk profiles. Using these factors, we identified 24 groups with a cumulative incidence of severe liver disease at 10 years ranging from 0.2% (age 35-65, low FIB-4, no diabetes or impaired glucose and normal gGT) to 32.1% (age 35-65, high FIB-4, diabetes or impaired glucose and high gGT).

Conclusions: Identification of subjects at increased risk of severe liver disease in the general population using the FIB-4 score can be substantially improved by adding age and specific biomarkers commonly available in the primary care setting. These parameters should be considered for inclusion in the development of future risk prediction models.

Keywords: NAFLD; alcohol-related liver disease; cirrhosis; epidemiology; prediction.

PubMed Disclaimer

Conflict of interest statement

This study was directly supported by a research grant from Astra Zeneca to HH:s institution.

Figures

FIGURE 1
FIGURE 1
Heat map of 10‐year cumulative incidence of severe liver disease using the four selected predictors. gGT, gamma‐glutamyltransferase. *Group contained 57 persons and no events
See this image and copyright information in PMC

Comment in

References

    1. Pimpin L, Cortez‐Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69:718–35. - PubMed
    1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70:151–71. - PubMed
    1. Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11–20. - PubMed
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease‐meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. - PubMed
    1. Williams R, Aspinall R, Bellis M, Camps‐Walsh G, Cramp M, Dhawan A, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384:1953–97. - PubMed

Publication types