Performance of routine risk scores for predicting cirrhosis-related morbidity in the community

Innes, Hamish; Morling, Joanne R.; Buch, Stephan; Hamill, Victoria; Stickel, Felix; Guha, Indra Neil

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.

Citation

Innes, H., Morling, J. R., Buch, S., Hamill, V., Stickel, F., & Guha, I. N. (2022). Performance of routine risk scores for predicting cirrhosis-related morbidity in the community. Journal of Hepatology, 77(2), 365-376. https://doi.org/10.1016/j.jhep.2022.02.022

• Journal Article Type: Article
• Acceptance Date: Feb 14, 2022
• Online Publication Date: Mar 7, 2022
• Publication Date: Aug 1, 2022
• Deposit Date: Mar 8, 2022
• Publicly Available Date: Mar 8, 2023
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Electronic ISSN: 1600-0641
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 77
• Issue: 2
• Pages: 365-376
• DOI: https://doi.org/10.1016/j.jhep.2022.02.022
• Keywords: invasive tests; NITs; liver fibrosis; NAFLD; alcohol liver disease; prognosis; genetics; single nucleotide polymorphisms
• Public URL: https://nottingham-repository.worktribe.com/output/7565833
• Publisher URL: https://www.journal-of-hepatology.eu/article/S0168-8278(22)00129-5/fulltext