Cirrhosis Risk Calculator Outperforms Others in Primary Care
Among nine risk scores, the SAFE calculator provided the greatest net benefit for predicting 10-year cirrhosis risk in patients with steatotic liver disease. All tools showed minimal utility for predicting hepatocellular carcinoma. The findings support using SAFE to guide counseling and repeat assessments in primary care.
The SAFE calculator combines seven readily accessible clinical measures—age, body mass index, diabetes status, two liver enzymes, globulins, and platelet count—making it practical for routine primary care workflows. Researchers evaluated nine risk scores for predicting cirrhosis or hepatocellular carcinoma within 10 years among patients with steatotic liver disease, finding SAFE delivered the strongest net benefit for cirrhosis detection while all tools performed poorly for liver cancer prediction.
Current guidance from the American Association for the Study of Liver Diseases recommends repeated screening with the Fibrosis-4 Index, but investigators noted this tool lacks sensitivity and specificity. The SAFE score's advantage suggests it could reduce both missed cases of advanced disease and unnecessary secondary testing in patients with benign steatosis, supporting development of structured screening pathways in primary care.
The findings could help primary care physicians identify which patients with steatotic liver disease genuinely need closer monitoring for cirrhosis, potentially reducing both under-detection of silent liver disease and wasteful referrals for low-risk patients. If adopted broadly, the SAFE score may enable more efficient use of specialty resources and give patients clearer guidance about their long-term risk. However, the persistent weakness of all tools for hepatocellular carcinoma screening means liver cancer detection may continue to rely on other strategies, leaving an important gap in comprehensive liver care.