SAFE score-based approach more effective than current guidelines for liver fibrosis

A recent study has found the proposed population risk stratification approach using the Steatosis-Associated Fibrosis Estimator (SAFE) score to be simpler and more effective than current guidelines.

The novel approach identifies more patients with liver fibrosis and requires less resources than the currently recommended algorithm.

The authors used the National Health and Nutrition Examination Survey data (2017–2020), in which a sample of the US civilian population underwent vibration-controlled transient elastography (VCTE). 

The current guideline and a new SAFE-based proposal were applied to these data to predict the number of individuals to be diagnosed with liver fibrosis, gauged by liver stiffness measurement (LSM), including significant (LSM ≥8 kPa) and advanced (LSM ≥12 kPa) fibrosis, as well as the number of VCTEs to be performed.

Overall, 2,691 individuals, projecting to a total of 75.8 million US adults, had metabolic dysfunction-associated steatotic liver disease (MASLD). Of these, 11 percent had LSM 8–12 kPa, and 6 percent had LSM ≥12 kPa.

When using the current guideline, 18.1 million VCTEs would be needed to diagnose 3.5 million individuals with LSM ≥8 kPa and 1.7 million with LSM ≥12 kPa.

On the other hand, application of the new approach based on the SAFE score would detect 4.9 million individuals with LSM ≥8 kPa and 2.5 million with LSM ≥12 kPa (37-percent and 45-percent improvement over the current guideline, respectively), while requiring 5.0 million fewer VCTEs (28-percent decrease).

"Current guidelines recommend using the Fibrosis-4 score for initial identification of individuals at risk of future complications,” the authors said.