| Title: | Validated early detection metrics reduce the population requiring liver fibrosis screening |
| Journal: | Gastroenterology |
| Published: | 15 Jun 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/42297049/ |
| DOI: | https://doi.org/10.1053/j.gastro.2026.06.003 |
Publication 20634
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Abstract
BACKGROUND & AIMS: Current guideline-defined indicators for fibrosis screening identify a large proportion of the general population, burdening health care resources. We aimed to evaluate and refine indicators for fibrosis screening.</p>
METHODS: We included adults aged 18-80 years from the National Health and Nutrition Examination Survey 2017-2020 data with a body mass index ≥18.5 kg/m2 without excessive alcohol use. We obtained the weighted proportions of individuals across stratified screening indicators and targeted only subgroups with ≥10% liver stiffness measurement (LSM ≥8 kPa) risk for screening. These refined criteria were validated and linked with liver-related events in 4 general-population cohorts.</p>
RESULTS: The derivation cohort included 5904 adults (8.9% LSM ≥8 kPa). Current guidelines identified 60%-76% as screening-eligible, yielding an LSM ≥8 kPa prevalence of 11%-14% among those screening eligible and 2% among those not eligible. Our refined strategy targeted 22% for screening, increasing prevalence to 28% among those screening-eligible, while maintaining low prevalence (4%) in those not eligible. In the pooled validation cohort (n = 13,295; 7.0% LSM ≥8 kPa), 14% met the refined criteria. Results remained consistent across thresholds: LSM ≥8, ≥10, and ≥12 kPa prevalence among screening-eligible individuals was 22%, 13%, and 8%, respectively, and 4%, 2%, and 1% among those not eligible. In the UK Biobank (n = 282,852), individuals meeting the refined criteria had an approximately 6-fold higher 10-year risk of incident cirrhosis (0.99% vs 0.18%) and liver-related death (0.40% vs 0.07%).</p>
CONCLUSIONS: Current recommendations target 60%-76% of adults for fibrosis screening. Our refined strategy reduced this to 10%-22%, achieving significantly higher disease prevalence among those eligible for screening, while maintaining a very low risk of increased LSM or liver-related events in those not eligible for screening.</p>
17 Authors
- Laurens A van Kleef
- Jesse Pustjens
- Carolin V Schneider
- Guillem Pera
- Pere Toran
- Maurice Michel
- Kai M Schneider
- Adriaan G Holleboom
- Manuel Castro Cabezas
- Maarten E Tushuizen
- Harry L A Janssen
- Jörn M Schattenberg
- Pere Gines
- Sven M Francque
- Zobair M Younossi
- Aleksander Krag
- Willem Pieter Brouwer
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