The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care.
The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care.
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脂肪变性相关纤维化估计器 (SAFE) 评分：初级保健中检测低风险 NAFLD 的工具。
DOI：
10.1002/hep.32545
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kwong,AllisonJ
中科院分区：
文献类型：
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作者：
Sripongpun,Pimsiri;Kim,WRay;Mannalithara,Ajitha;Charu,Vivek;Vidovszky,Anna;Asch,Steven;Desai,Manisha;Kim,SunH;Kwong,AllisonJ
背景：NAFLD在初级保健中很常见。肝纤维化2期或更高（≥ F2）会增加未来发病和死亡的风险。我们开发并验证了一个评分，以帮助初步评估非酒精性脂肪肝在初级care.Methods肝纤维化的患者活检证实NAFLD的数据提取自NASH临床研究网络观察性研究（n= 676）。使用逻辑回归和机器学习方法，我们构建了预测模型，以区分≥ F2和F0/1。在试验中的参与者（“FLINT”，n= 280）和具有磁共振弹性成像数据的NAFLD当地患者（n= 130）中测试模型。结果：选择多变量logistic回归模型作为脂肪变性相关纤维化评估（SAFE）评分，该评分包括年龄、体重指数、糖尿病、血小板、天冬氨酸和丙氨酸转氨酶以及球蛋白（血清总蛋白减去白蛋白）。该模型产生的受试者工作特征曲线下面积≥ 0.80，用于区分测试数据集中的F0/1与≥ F2，始终高于纤维化-4和NAFLD纤维化评分。在两个测试集中，SAFE为0时排除≥ F2的阴性预测值分别为88%和92%。在NHANES III组中，SAFE< 0的受试者的25年生存期与无脂肪变性的受试者相当（p= 0.34），而SAFE> 100的受试者的SAFE评分增加与较短的生存期相关，校正HR为1.53（p< 0.01）。结论：SAFE评分使用广泛可用的变量来估计诊断为NAFLD的患者的肝纤维化，可用于初级保健以识别低风险NAFLD。
Background:NAFLD is common in primary care. Liver fibrosis stage 2 or higher (≥ F2) increases future risk of morbidity and mortality. We developed and validated a score to aid in the initial assessment of liver fibrosis for NAFLD in primary care.Methods:Data from patients with biopsy‐proven NAFLD were extracted from the NASH Clinical Research Network observational study (n= 676). Using logistic regression and machine‐learning methods, we constructed prediction models to distinguish≥ F2 from F0/1. The models were tested in participants in a trial (“FLINT,” n= 280) and local patients with NAFLD with magnetic resonance elastography data (n= 130). The final model was applied to examinees in the National Health and Nutrition Examination Survey (NHANES) III (n= 11,953) to correlate with long‐term mortality.Results:A multivariable logistic regression model was selected as the Steatosis‐Associated Fibrosis Estimator (SAFE) score, which consists of age, body mass index, diabetes, platelets, aspartate and alanine aminotransferases, and globulins (total serum protein minus albumin). The model yielded areas under receiver operating characteristic curves≥ 0.80 in distinguishing F0/1 from≥ F2 in testing data sets, consistently higher than those of Fibrosis‐4 and NAFLD Fibrosis Scores. The negative predictive values in ruling out≥ F2 at SAFE of 0 were 88% and 92% in the two testing sets. In the NHANES III set, survival up to 25 years of subjects with SAFE< 0 was comparable to that of those without steatosis (p= 0.34), whereas increasing SAFE scores correlated with shorter survival with an adjusted HR of 1.53 (p< 0.01) for subjects with SAFE> 100.Conclusion:The SAFE score, which uses widely available variables to estimate liver fibrosis in patients diagnosed with NAFLD, may be used in primary care to recognize low‐risk NAFLD.