Revisiting the steatosis‐associated fibrosis estimator score in young Asian subjects with steatotic liver disease and consideration for population variability

• Published in: Journal of gastroenterology and hepatology Vol. 39; no. 10; pp. 2112 - 2119
• Main Authors: Yang, Jiwon, Choi, Won‐Mook, Lee, Danbi, Shim, Ju Hyun, Kim, Kang Mo, Lim, Young‐Suk, Lee, Han Chu, Choi, Jonggi
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.10.2024
• Subjects: Adult; Age Factors; Asian People; Biological Variation, Population; Biopsy; Body Mass Index; Clinical significance; Fatty liver; Fatty Liver - diagnosis; Fatty Liver - epidemiology; Fatty Liver - etiology; Female; Fibrosis; Humans; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver diseases; liver fibrosis; Male; Middle Aged; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - pathology; noninvasive test; Organ donors; Performance evaluation; Prevalence; Retrospective Studies; Severity of Illness Index; Steatosis; steatotic liver disease; the steatosis‐associated fibrosis estimator score; Young Adult; the steatosis‐associated fibrosis estimator score; noninvasive test; liver fibrosis; steatotic liver disease
• ISSN: 0815-9319; 1440-1746; 1440-1746
• DOI: 10.1111/jgh.16656

Background and Aim The steatosis‐associated fibrosis estimator (SAFE) score has been developed to distinguish clinically significant fibrosis in patients with steatotic liver disease (SLD). However, validation of its performance in Asian subjects is limited. This study aimed to evaluate the performance of the SAFE score in Asian subjects with biopsy‐proven SLD and in different subgroups according to age, sex, and body mass index. Methods We retrospectively analyzed 6383 living liver donors who underwent a liver biopsy between 2005 and 2023. Of these, 1551 subjects with biopsy‐proven SLD were included. The performance of the SAFE score was evaluated using areas under the curve and compared with those of the nonalcoholic fatty liver disease fibrosis score (NFS) and fibrosis‐4 index (FIB‐4). Results The prevalence of clinically significant fibrosis in the cohort was 2.2%. The proportion of subjects with a “low‐risk” SAFE score was the highest (91.0%), followed by those with “intermediate‐risk” (7.8%) and “high‐risk” (1.2%) scores. The prevalence of fibrosis in subjects with low‐risk, intermediate‐risk, and high‐risk scores was 1.6%, 6.6%, and 21.1%, respectively. The SAFE outperformed FIB‐4 and NFS (area under the curve: 0.70 vs 0.64 for both NFS and FIB‐4). However, it showed low diagnostic accuracy and sensitivity (27%) at the low cutoff (SAFE < 0) in subjects aged 30–39 years (fibrosis: 1.2%), despite having a high negative predictive value (0.99). Conclusion While the SAFE score demonstrates superior performance compared with other noninvasive tests in Asian subjects with SLD, its performance varies across age groups. In younger subjects, particularly, its performance may be more limited.