Performance of routine risk scores for predicting cirrhosis-related morbidity in the community

Integrating genetic variants into clinical models for hepatocellular carcinoma risk stratification in cirrhosis

“…In addition, while the prospective design of these longitudinal cohorts limits the ability to follow-up large numbers of patients using standardised surveillance protocols recorded in clinical centres in the long term, such a rigorous approach means that our conclusions can be interpreted with confidence. This clinical approach is in sharp contrast with the aforementioned registry studies, 10,42 which in turn suffer from limited clinical information and outcomes. These statistical issues provide further justification to combine patients with cirrhosis and HCV eradication with other causes of non-viral liver diseases, as highlighted by the development of universal scoring systems such as the aMAP score.…”

“…Our results are in line with a recent report conducted in patients with HCV-cured cirrhosis, albeit HCC occurrence was not the specific outcome studied. 41 A similar analysis was performed in nearly 200,000 UK biobank participants, which evaluated the enrichment of several liver prognostic scoring systems by several SNPs; 42 although the outcome was also a mixed endpoint encompassing "liver-related complications", this large-scale study showed that the most performant scores were similarly only marginally improved by the addition of genetic variants. Nevertheless, other analyses conducted in the very same UK biobank yielded opposite conclusions: 43 this fact once again highlights the pivotal role of prospective cohorts of patients with pre-defined outcomes and events accurately recorded in clinical centres for delineating the basis of future precision medicine.…”

Genetic Variation of SAMM50 Is Not an Independent Risk Factor for Alcoholic Hepatocellular Carcinoma in Caucasian Patients

“…In patients at risk for alcoholic HCC, the development of a genetic risk score might be particularly useful to tailor screening investigations, which are recommended by international guidelines for all patients at risk [ 2 , 3 ]. Because the genetic risk factors discovered so far are not sufficiently precise to define subgroups for screening in alcohol-associated cirrhosis [ 27 ], new genetic risk factors for HCC are investigated. Among others, a common variant in the toll-like receptor 5 , rs5744174, was linked to the development of HCC [ 28 ], while genetic variation in platelet receptors does not seem to play a role [ 29 ].…”

Taking a risk-based approach to testing for liver disease in primary care, a step in the right direction

“…Supplementary data to this article can be found online at https:// doi.org/10.1016/j.jhep.2022.03.038. 15 and the 10-year risk of clinical events (in blue) 12 highlight the difference in case identification according to the different thresholds. cACLD, compensated advanced chronic liver disease; FIB-4, fibrosis-4.…”

“…11 In this issue of Journal of Hepatology, Innes et al evaluated 20 currently available risk scores in 197,509 persons from the UK Biobank population at risk of chronic liver disease (defined by excess alcohol consumption, obesity, or type 2 diabetes mellitus) to identify persons at high risk of liver-related morbidity over a 10-year horizon. 12 Rather than using these risk scores for the purpose that the majority were developed for, i.e. to determine stage of liver fibrosis, the underlying idea was to identify a prediction rule for liver disease events, to parallel QRISK3 that is used to estimate the 10-year risk of cardiovascular disease in the general population.…”