Risk score to predict fibrosis among Mexican adults: results of the Health Workers Cohort Study

TL;DR

This study created a non-invasive risk score to predict liver fibrosis in Mexican adults using clinical and biochemical data, offering a less costly alternative to liver biopsy.

Contribution

A novel fibrosis risk score tailored for the Mexican population with high diagnostic accuracy was developed and validated.

Findings

The risk score achieved an AUROC of 81.1% for fibrosis detection in the Mexican population.

The score outperformed existing tools like the BARD score and AST/ALT ratio in diagnostic accuracy.

It uses routinely available data, making it suitable for primary care settings.

Abstract

Fibrosis, a severe complication of metabolic-associated fatty liver disease, represents a major concern in the disease progression. Although liver biopsy remains the gold standard for fibrosis diagnosis, its invasive nature and high cost highlight the need for reliable non-invasive alternatives.

This study aimed to develop a simple, non-invasive fibrosis risk score based on clinical and biochemical variables in a Mexican population.

A total of 295 participants from the Health Workers Cohort Study were included. Fibrosis was assessed using transient elastography (FibroScan), which served as the reference standard for the development and validation of the risk score. Participants were classified according to the Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) system. The diagnostic performance of candidate predictors was evaluated using receiver operating characteristic (ROC) curve analysis, and optimal cutoffs for fibrosis detection were identified.

The fibrosis risk score developed for the Mexican population, including sex, triglycerides, glucose, waist circumference, hypertension, high-density lipoprotein cholesterol, body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and insulin, achieved an area under the ROC (AUROC) of 81.1% (95% CI, 74.4, 87.8). In the subsample with available insulin measurements, the AUROC was comparable (79.8, 95% CI, 72.9–86.8). When compared with existing fibrosis scores, including the BARD score (based on BMI, aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and type 2 diabetes) and the AST/ALT ratio, the newly developed score demonstrated superior diagnostic accuracy for fibrosis detection.

This fibrosis risk score, based on routinely available clinical and biochemical data, demonstrated high diagnostic accuracy in the Mexican adult population. As a non-invasive tool, it may facilitate the early identification of fibrosis in primary care settings and reduce the need for liver biopsy. Further validation in larger and more diverse populations is warranted.

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