Routine risk scores predict cirrhosis-related morbidity

A recent study has found that accessible risk scores obtained from routine blood tests, particularly aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4), can be repurposed to predict the 10-year risk of cirrhosis morbidity in an individual in the community setting.

Notably, although genetic data can improve performance of risk scores, the effect is only minimal, according to the researchers.

This study employed a two-stage design. In stage 1, the researchers conducted a systematic review to identify risk scores derived from routine liver blood tests that have exhibited prior ability to estimate cirrhosis-related complications. They tested the risk scores in a UK Biobank subgroup, which consisted of individuals with a risk factor for chronic liver disease (stage 2).

Cirrhosis complications referred to hospitalizations for liver cirrhosis or presentation with hepatocellular carcinoma. Finally, the researchers assessed discrimination of risk scores with and without genetic data using the Wolbers C-index, Harrell’s adequacy index, and cumulative incidence curves.

The stage-1 systematic review identified 20 risk scores, while the stage-2 phase included a total of 197,509 participants from the UK Biobank. The 10-year cumulative incidence of cirrhosis complications was 0.58 percent (95 percent confidence interval [CI], 0.54‒0.61; n=1,110 events).

APRI (C-index, 0.804, 95 percent CI, 0.788‒0.820) and FIB-4 (C-index, 0.780, 95 percent CI, 0.764‒0.795) were the top performing risk scores. At 10 years, the cumulative incidences of cirrhosis complications for participants with an APRI score exceeding the 90th, 95th, and 99th percentile were 3.30 percent, 5.42 percent, 14.83 percent, respectively.

The addition of established genetic risk loci associated with cirrhosis provided <5 percent of new prognostic information to the APRI score and modestly improved the C-index (ie, from 0.804 to 0.809).

“New approaches are needed in community settings to reduce the late diagnosis of chronic liver disease,” the researchers said.