Steatotic Liver Disease Risk Scores Compared for Predicting Cirrhosis

FRIDAY, Sept. 25, 2026 (HealthDay News) — For patients with steatotic liver disease (SLD), the steatosis-associated fibrosis estimator (SAFE) score demonstrated the greatest net benefit for predicting cirrhosis, according to a study published online Sept. 21 in JAMA Internal Medicine.

Catherine Mezzacappa, M.D., Ph.D., M.P.H., from the Yale School of Medicine in New Haven, Connecticut, and colleagues compared the clinical utility of SLD risk scores for predicting cirrhosis and hepatocellular carcinoma (HCC) in patients with noncirrhotic SLD in a cohort study using data from the national U.S. Veterans Affairs health system for adults with imaging-confirmed SLD. Nine clinical risk scores were evaluated for prediction of cirrhosis or HCC within 10 years.

The analysis included 853,131 patients, of whom 3.96 percent developed cirrhosis and 0.35 percent developed HCC within 10 years. The greatest discrimination of cirrhosis risk was demonstrated by the fibrosis-4 index (FIB-4), the aspartate aminotransferase-to-platelet ratio, and SAFE scores; the greatest discrimination of HCC risk was demonstrated by the SAFE, Tate, and FIB-4 scores. The greatest net benefit for predicting cirrhosis was demonstrated by the SAFE score, with a score of 29.5 corresponding to a 10-year cirrhosis risk of 2.5 percent and net benefit of 0.019 (1.9 additional individuals who develop cirrhosis per 100 classified as at-risk). The SAFE score had a net benefit of 0.0016 at a 0.25 percent 10-year risk for HCC.

“This comparative validation study highlights the importance of assessing test performance at relevant thresholds for clinical practice,” the authors write.

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