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The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population
Noninvasive tests are important in the initial risk stratification of people at risk of fibrosis. The recently developed steatosis-associated fibrosis estimator (SAFE) score may have such potential but awaits external validation. METHODS: We analyzed 6973 participants aged 18–80 in the National Heal...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079343/ https://www.ncbi.nlm.nih.gov/pubmed/37026734 http://dx.doi.org/10.1097/HC9.0000000000000075 |
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author | van Kleef, Laurens A. de Knegt, Robert J. Ayada, Ibrahim Pan, Qiuwei Brouwer, Willem Pieter |
author_facet | van Kleef, Laurens A. de Knegt, Robert J. Ayada, Ibrahim Pan, Qiuwei Brouwer, Willem Pieter |
author_sort | van Kleef, Laurens A. |
collection | PubMed |
description | Noninvasive tests are important in the initial risk stratification of people at risk of fibrosis. The recently developed steatosis-associated fibrosis estimator (SAFE) score may have such potential but awaits external validation. METHODS: We analyzed 6973 participants aged 18–80 in the National Health and Nutrition Examination Survey 2017-2020 cycle with data on liver stiffness and SAFE score without prevalent heart failure. Fibrosis was defined as liver stiffness ≥8.0 kPa. Accuracy was evaluated by AUC and assessment of test characteristics at the prespecified cutoffs for ruling out/ruling in fibrosis. RESULTS: The SAFE score categorized 14.7% of the population as high risk, 30.4% as intermediate risk, and 54.9% as low risk for fibrosis. The actual fibrosis prevalence in these groups was 28.0%, 10.9%, and 4.0%, respectively, translating into a positive predictive value of 0.28 at the high-risk cutoff and a negative predictive value of 0.96 at the low-risk cutoff. The AUC of the SAFE score (0.748) was significantly higher than the fibrosis-4 index (0.619) or NAFLD fibrosis score (0.718). However, test performance strongly depended on age categories: 90% of participants aged 18–40 years were considered at low risk for fibrosis, including 89/134 (66%) of clinically significant fibrosis cases. In the oldest group (60–80 y), fibrosis could only be safely ruled out among 17%, corresponding to a high referral rate of up to 83%. The best SAFE score performance was found in the middle-aged group (40–60 y). The results were consistent in target populations with metabolic dysfunction or steatosis. CONCLUSIONS: The SAFE score has overall good diagnostic accuracy in detecting fibrosis but was highly dependent on age. The SAFE score lacked sensitivity in younger populations and the ability to rule out fibrosis in older populations. |
format | Online Article Text |
id | pubmed-10079343 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-100793432023-04-07 The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population van Kleef, Laurens A. de Knegt, Robert J. Ayada, Ibrahim Pan, Qiuwei Brouwer, Willem Pieter Hepatol Commun Original Article Noninvasive tests are important in the initial risk stratification of people at risk of fibrosis. The recently developed steatosis-associated fibrosis estimator (SAFE) score may have such potential but awaits external validation. METHODS: We analyzed 6973 participants aged 18–80 in the National Health and Nutrition Examination Survey 2017-2020 cycle with data on liver stiffness and SAFE score without prevalent heart failure. Fibrosis was defined as liver stiffness ≥8.0 kPa. Accuracy was evaluated by AUC and assessment of test characteristics at the prespecified cutoffs for ruling out/ruling in fibrosis. RESULTS: The SAFE score categorized 14.7% of the population as high risk, 30.4% as intermediate risk, and 54.9% as low risk for fibrosis. The actual fibrosis prevalence in these groups was 28.0%, 10.9%, and 4.0%, respectively, translating into a positive predictive value of 0.28 at the high-risk cutoff and a negative predictive value of 0.96 at the low-risk cutoff. The AUC of the SAFE score (0.748) was significantly higher than the fibrosis-4 index (0.619) or NAFLD fibrosis score (0.718). However, test performance strongly depended on age categories: 90% of participants aged 18–40 years were considered at low risk for fibrosis, including 89/134 (66%) of clinically significant fibrosis cases. In the oldest group (60–80 y), fibrosis could only be safely ruled out among 17%, corresponding to a high referral rate of up to 83%. The best SAFE score performance was found in the middle-aged group (40–60 y). The results were consistent in target populations with metabolic dysfunction or steatosis. CONCLUSIONS: The SAFE score has overall good diagnostic accuracy in detecting fibrosis but was highly dependent on age. The SAFE score lacked sensitivity in younger populations and the ability to rule out fibrosis in older populations. Lippincott Williams & Wilkins 2023-04-04 /pmc/articles/PMC10079343/ /pubmed/37026734 http://dx.doi.org/10.1097/HC9.0000000000000075 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Original Article van Kleef, Laurens A. de Knegt, Robert J. Ayada, Ibrahim Pan, Qiuwei Brouwer, Willem Pieter The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title | The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title_full | The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title_fullStr | The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title_full_unstemmed | The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title_short | The Steatosis-associated fibrosis estimator (SAFE) score: validation in the general US population |
title_sort | steatosis-associated fibrosis estimator (safe) score: validation in the general us population |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079343/ https://www.ncbi.nlm.nih.gov/pubmed/37026734 http://dx.doi.org/10.1097/HC9.0000000000000075 |
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