Comparison of various strategies to define the optimal target population for liver fibrosis screening: A population‐based cohort study

Abstract Background & Aims Liver fibrosis screening is recommended in high‐risk populations, but the optimal definition of “high risk” remains to be established. We compared the performance of several risk‐stratification strategies in a population‐based setting. Methods Data were obtained from the Finnish population‐based health examination surveys Health 2000 and FINRISK 2002–2012. The Chronic Liver Disease Risk Score (CLivD) was compared to previously published risk‐stratification strategies based on elevated liver enzymes, alcohol use, diabetes, fatty liver index, body mass index, and/or metabolic risk factors for their ability to detect either advanced liver fibrosis or incident severe liver events. Advanced fibrosis was defined as an Enhanced Liver Fibrosis (ELFTM) score >9.8 in the Health 2000 study (n = 6084), and incident liver events were ascertained from registry linkage in the combined FINRISK 2002–2012 and Health 2000 cohort (n = 26,957). Results Depending on the cohort, 53%–60% of the population was considered at risk using the CLivD strategy (low‐intermediate‐high risk, excluding the minimal‐risk category), compared to 30%–32% according to the other risk‐stratification strategies. The CLivD captured 85%–91% of cases in the population with advanced liver fibrosis and 90% of incident severe liver events within 10 years from baseline. This compares to 33%–44% and 56%–67% captured by the other risk‐stratification strategies, respectively. The 10‐year cumulative incidence of liver events varied by risk‐stratification strategy (1.0%–1.4%). Conclusions Compared to previously reported traditional risk factor‐based strategies, use of the CLivD captured substantially more cases with advanced liver disease in the population and may be superior for targeting further fibrosis screening.