Steatotic Liver Disease Risk Scores to Predict Cirrhosis and Hepatocellular Carcinoma.

In noncirrhotic steatotic liver disease within the US Veterans Affairs system, the SAFE score best predicted 10-year cirrhosis risk, with a threshold of 29.5 mapping to 2.5% risk.

• Why it matters: Many people with steatotic liver disease never progress to advanced outcomes, so clinicians need evidence on which risk scores can meaningfully guide surveillance for cirrhosis and hepatocellular carcinoma.
• What they did: A cohort of 853,131 adults with imaging-confirmed SLD (2008–2020) without viral hepatitis or primary liver disease had nine 10-year risk scores calculated at first steatosis imaging and were followed for cirrhosis or HCC. Cox models produced time-dependent 10-year probabilities and decision-curve net benefit across risk thresholds.
• The result: SAFE showed the greatest net benefit for cirrhosis prediction (net benefit 0.019; 1.9 additional cirrhosis cases per 100 at-risk classifications), while HCC risk scores had minimal utility for screening decisions.

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