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Abstract Details
Performance of routine risk scores for predicting cirrhosis-related morbidity in the community
J Hepatol. 2022 Mar 7;S0168-8278(22)00129-5. doi: 10.1016/j.jhep.2022.02.022.Online ahead of print.
Hamish Innes1, Joanne R Morling2, Stephan Buch3, Victoria Hamill4, Felix Stickel5, Indra Neil Guha6
Author information
School of Health and Life Sciences; Glasgow Caledonian University. Glasgow UK; Public Health Scotland, Glasgow, UK; Lifespan and Population Health, University of Nottingham, Nottingham, UK. Electronic address: Hamish.Innes@gcu.ac.uk.
Lifespan and Population Health, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, NG7 2UH, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, NG7 2UH, UK.
Medical Department 1, University Hospital Dresden, TU Dresden, Germany.
School of Health and Life Sciences; Glasgow Caledonian University. Glasgow UK; Public Health Scotland, Glasgow, UK.
Department of Gastroenterology and Hepatology, University Hospital of Zurich, Switzerland.
NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, NG7 2UH, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, NG7 2UH, UK.
Abstract
Background & aims: Models predicting an individual's ten-year risk of cirrhosis complications have not been developed for a community setting. Our objectives were to assess the performance of existing risk scores - both with and without genetic data - for predicting cirrhosis complications in the community.
Methods: We used a two-stage study design. In stage 1, a systematic review was conducted to identify risk scores derived from routine liver blood tests that have demonstrated prior ability to predict cirrhosis-related complication events. Risk scores identified from stage 1 were tested in a UK Biobank subgroup, comprising participants with a risk factor for chronic liver disease (stage 2). Cirrhosis complications were defined as hospitalisation for liver cirrhosis or presentation with hepatocellular carcinoma. Discrimination of risk scores with and without genetic data was assessed using the Wolbers C-index, Harrell's adequacy index, and cumulative incidence curves.
Results: Twenty risk scores were identified from the stage-1 systematic review. For stage-2, 197,509 UK biobank participants were selected. The cumulative incidence of cirrhosis complications at ten years was 0.58%; 95%CI:0.54-0.61 (1110 events). The top performing risk scores were APRI (C-index: 0.804; 95%CI: 0.788-0.820) and FIB4 (C-index: 0.780; 95%CI: 0.764-0.795). The ten-year cumulative incidence of cirrhosis complications for participants with an APRI score exceeding the 90th 95th and 99th percentile was 3.30%, 5.42% and 14.83%, respectively. Inclusion of established genetic risk loci associated with cirrhosis added <5% of new prognostic information to the APRI score and improved the C-index only minimally (i.e. from 0.804 to 0.809).
Conclusions: Accessible risk scores derived from routine blood tests can be repurposed for estimating ten-year risk of cirrhosis morbidity in the community (particularly APRI and FIB4). Genetic data improves performance only minimally.