A new study from Karolinska Institutet, published in the scientific journal The BMJ, shows that a simple blood test can predict the risk of developing severe liver disease. The method could be used in primary care right now, helping to detect cirrhosis and liver cancer earlier.
In the study, researchers at Karolinska Institutet, together with colleagues in Finland, evaluated how good the method is at calculating the risk of serious liver complications.
– These are diseases that are becoming increasingly common and have a poor prognosis if detected late.
Our method can predict the risk of falling ill within ten years and is based on three simple blood tests that are already routinely taken,” says Rickard Strandberg, affiliated researcher at the Department of Medicine, Huddinge, Karolinska Institutet, who developed the test together with Hannes Hagström at the same department.
Hannes Hagström, Chief Physician and Adjunct Professor, Karolinska Institutet Photo: Rickard Kilström
The model, called CORE, was developed using advanced statistical methods and is based on five factors: age, gender, and levels of three common liver values (AST, ALT and GGT), which are measured at many health checks.
A web-based calculator
The aim has been to develop a tool that is easy to use in primary care, where most patients first seek care. A web-based calculator is already available to health professionals at www.core-model.com.
– This is an important step towards offering early screening for liver disease in primary care. Drug treatment is now available, soon also in Sweden, to treat people at high risk of developing liver disease,” says Hannes Hagström, Adjunct Professor at the Department of Medicine, Huddinge, Karolinska Institutet and Chief Physician at Karolinska University Hospital, who led the research.
The study is based on data from over 480 000 people in Stockholm who underwent health checks between 1985 and 1996. The researchers followed the participants for up to 30 years and found that about 1.5% developed serious liver disease, such as cirrhosis, liver cancer or the need for a liver transplant.
High accuracy
The CORE model proved to be highly accurate: it was able to distinguish between people who developed disease and those who did not in 88% of cases, which is better than the currently recommended FIB-4 method.
– There has been a lack of good tools in primary care to detect the risk of severe liver disease in time. FIB-4 is not adapted for the general population and is less effective in predicting future risk of severe liver disease,” says Hannes Hagström.
The model was also tested on two other populations in Finland and the UK, where it also showed good ability to predict risk. The researchers emphasize that it needs to be further tested in groups at particularly high risk, such as people with type 2 diabetes or obesity. They also see a need to integrate the model into medical record systems to facilitate its use in healthcare.
The study is a collaboration between researchers at Karolinska Institutet, Helsinki University Hospital, the University of Helsinki and the Finnish Institute for Health and Welfare. It has been funded by the Swedish Research Council, Region Stockholm (CIMED) and the Swedish Cancer Society. Hannes Hagström has several collaborations with the pharmaceutical industry on liver disease prognosis, but none relevant to the current study.
Publication – Use of new CORE risk score to predict 10 year risk of liver cirrhosis in general population: population based cohort study
