The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care
Abstract
脂肪变性相关纤维化评估（SAFE）评分：一种在初级保健中检测低风险NAFLD的工具
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.
背景：NAFLD在初级保健中很常见。肝纤维化2期或更高（≥F2）会增加未来发病率和死亡率的风险。我们开发并验证了一个评分，以帮助初级保健中NAFLD肝纤维化的初步评估。
肝活检METAVIR评分系统：F0/1：无/轻度肝纤维化；≥F2：显著肝纤维化
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.
方法：从NASH临床研究网络观察性研究（n=676）中提取活检证实的NAFLD患者的数据。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。在试验参与者（“FLINT”，n=280）和本地NAFLD患者（n=130）中使用磁共振弹性成像数据对模型进行了测试。最终模型应用于国家健康和营养调查（NHANES）III（n=11953）中的受试者，与长期死亡率相关。
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.
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，该评分由年龄、体重指数、糖尿病、血小板、天冬氨酸和丙氨酸氨基转移酶以及球蛋白（血清总蛋白减去白蛋白）组成。在测试数据集中，该模型在区分F0/1和≥F2时得出的受试者操作特征曲线下面积≥0.80，始终高于FIB-4和NAFLD纤维化评分。在两个测试集中，当SAFE为0时，排除≥F2的阴性预测值分别为88%和92%。在国家健康和营养调查（NHANES）III组中，SAFE＜0的受试者与没有脂肪变性的受试者相比25年生存率相当（p＝0.34），而SAFE评分的增加与较短的生存率相关，SAFE＞100的受试者的校正HR为1.53（p＜0.01）。
NAFLD 纤维化评分（NAFLD fibrosis score，NFS）= -1.675+0.037×年龄+0.094×体质量指数（BMI，kg/m²）+1.13×是否糖耐量受损或糖尿病（是即为1，否即为0）+0.99×AST/ALT 比值-0.013×血小板（10⁹/L）-0.66×白蛋白 (g/dl)。当 NFS > 0.676 时有 67% 的 灵敏度和 97% 的特异度提示肝脏已出现进展性纤维化｡。
FIB-4=（年龄 ×AST）/（血小板计数×ALT¹/²）。当 FIB4 指数 <1.45 时大概率排除肝进展性纤维化；当其>3.25 时倾向考虑出现进展性纤维化｡
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.
结论：SAFE评分使用广泛可用的变量来评估诊断为NAFLD患者的肝纤维化，可用于初级保健以识别低风险NAFLD。
Copyright © 2022 American Association for the Study of Liver Diseases.
Sripongpun P, Kim WR, Mannalithara A, Charu V, Vidovszky A, Asch S, Desai M, Kim SH, Kwong AJ. The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care. Hepatology. 2023 Jan 1;77(1):256-267. doi: 10.1002/hep.32545. Epub 2022 May 24. PMID: 35477908; PMCID: PMC9613815.
