Prevalence of Fibrosis and Applicability of Lab-Based Noninvasive Tests From Primary to Tertiary Care

作者：Georg Semmler, Paul Thöne, Jan Embacher, Philipp Hruska, Lucie Simonis, Katharina Stopfer, L. Fritz, Fiona Köck, Lorenz Balcar, Benedikt Hofer, Bernhard Wernly, Sophie Gensluckner, Michael Straßer, Andreas Völkerer, Katrine Prier Lindvig, Maja Thiele, Sarah Wernly, Robert Winker, Thomas Reiberger, Mattias Mandorfer, Michael Trauner, Christian Datz, TM Scherzer, Elmar Aigner · 发表于：Clinical Gastroenterology and Hepatology · 年份：2025 · DOI：10.1016/j.cgh.2025.09.008 · 被引用次数：9 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Nutrition and Health in Aging

BACKGROUND & AIMS: Knowing the prevalence of fibrosis, the accuracy of noninvasive tests, and their applicability in referral strategies of individuals screened or surveilled for steatotic liver disease is crucial for individual and policy decision making. METHODS: Five cohorts spanning primary to tertiary care between 2016 and 2024 were retrospectively included: individuals from the general population (colonoscopy screening, n = 1185, cohort I; primary care); at-risk individuals with metabolic dysfunction (overweight n = 1333, cohort II; prediabetes, n = 996, cohort III; secondary care); and subjects referred to hepatology clinics (n = 2598/n = 2397, cohort IV/V; tertiary care). RESULTS: Mean controlled attenuation parameter was 262 to 294 dB/m, and 41% to 64% showed hepatic steatosis. Suspected fibrosis (liver stiffness measurement [LSM] ≥8 kPa) was found in 6.4% of cohort I, 7.3%/6.8% of cohort II/III, and 21%/30% of cohort IV/V, whereas advanced fibrosis (≥12 kPa) was rare (1.2% in cohort I, 1.4%/0.8% in cohorts II/III, and 12%/17% in cohorts IV/V, respectively). The prevalence of fibrosis was especially high in subjects with obesity or diabetes, but not in overweight or prediabetes. Sensitivity of Fibrosis-4 index ≥1.3 for liver stiffness measurement ≥8 kPa was low in primary and secondary care (33%-44%) with simultaneously low positive predictive value (8.3%-12%), and overall low accuracy (area under the precision recall curve [AUPRC], 0.09-0.15). LiverPRO (AUPRC, 0.12-...