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

医学 糖尿病 队列 弗雷明翰风险评分 内科学 接收机工作特性 人口 生命银行 肝病 队列研究 风险评估 疾病 环境卫生 内分泌学 生物信息学 计算机安全 计算机科学 生物
作者
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,Shenghong Ju,Jie Shen,Jingli Gao,Linhua Zhao,Wai‐Kit Ming,Victor W. Zhong
出处
期刊:Med [Elsevier BV]
卷期号:5 (6): 570-582.e4 被引量:7
标识
DOI:10.1016/j.medj.2024.03.003
摘要

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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