Åberg, Fredrik, Luukkonen, Panu K., But, Anna, Salomaa, Veikko, Britton, Annie, Petersen, Kasper Meidahl, Bojesen, Stig Egil, Balling, Mie, Nordestgaard, Børge G., Puukka, Pauli, Männistö, Satu, Lundqvist, Annamari, Perola, Markus, Jula, Antti, and Färkkilä, Martti
Current screening strategies for chronic liver disease focus on detection of subclinical advanced liver fibrosis but cannot identify those at high future risk of severe liver disease. Our aim was to develop and validate a risk prediction model for incident chronic liver disease in the general population based on widely available factors. Multivariable Cox regression analyses were used to develop prediction models for liver-related outcomes with and without laboratory measures (Model lab and Model non-lab) in 25,760 individuals aged 40–70 years. Their data were sourced from the Finnish population-based health examination surveys FINRISK 1992-2012 and Health 2000 (derivation cohort). The models were externally validated in the Whitehall II (n = 5,058) and Copenhagen City Heart Study (CCHS) (n = 3,049) cohorts. The absolute rate of incident liver outcomes per 100,000 person-years ranged from 53 to 144. The final prediction model included age, sex, alcohol use (drinks/week), waist–hip ratio, diabetes, and smoking, and Model lab also included gamma-glutamyltransferase values. Internally validated Wolbers' C-statistics were 0.77 for Model lab and 0.75 for Model non-lab , while apparent 15-year AUCs were 0.84 (95% CI 0.75-0.93) and 0.82 (95% CI 0.74-0.91). The models identified a small proportion (<2%) of the population with >10% absolute 15-year risk for liver events. Of all liver events, only 10% occurred in participants in the lowest risk category. In the validation cohorts, 15-year AUCs were 0.78 (Model lab) and 0.65 (Model non-lab) in the CCHS cohort, and 0.78 (Model non-lab) in the Whitehall II cohort. Based on widely available risk factors, the C hronic Liv er D isease (CLivD) score can be used to predict risk of future advanced liver disease in the general population. Liver disease often progresses silently without symptoms and thus the diagnosis is often delayed until severe complications occur and prognosis becomes poor. In order to identify individuals in the general population who have a high risk of developing severe liver disease in the future, we developed and validated a C hronic Liv er D isease (CLivD) risk prediction score, based on age, sex, alcohol use, waist-hip ratio, diabetes, and smoking, with or without measurement of the liver enzyme gamma-glutamyltransferase. The CLivD score can be used as part of health counseling, and for planning further liver investigations and follow-up. [Display omitted] • Liver disease tends to develop silently without symptoms and thus the diagnosis is often delayed. • To improve early risk prediction, we developed and validated the CLivD score for use in the general population. • The CLivD score is based on age, sex, alcohol use, waist-hip ratio, diabetes, smoking, with or without GGT values. • The CLivD score provides accurate predictions of 15-year risk for future severe liver disease. • The CLivD score could be used as part of health counseling, and for planning further liver investigations and follow-up. [ABSTRACT FROM AUTHOR]