Risk score to predict fibrosis among Mexican adults: results of the Health Workers Cohort Study

Edgar Denova-Gutiérrez^1*Berenice Rivera-Paredez²Amado D. Quezada-Sánchez³Norberto Chávez-Tapia⁴Paloma Muñoz-Aguirre³Brianda Armenta-Guirado⁵Daniela Contreras⁶Yvonne N. Flores⁷Rafael Velazquez-Cruz⁸Jorge Salmeron²

• ¹National Institute of Public Health (Mexico), Cuernavaca, Mexico
• ²Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
• ³Instituto Nacional de Salud Publica, Cuernavaca, Mexico
• ⁴Medica Sur, Mexico City, Mexico
• ⁵Universidad de Sonora, Hermosillo, Mexico
• ⁶Centro de Estudios Universitarios Monterrey, Monterrey, Mexico
• ⁷University of California Los Angeles, Los Angeles, United States
• ⁸Instituto Nacional de Medicina Genomica, Mexico City, Mexico

Background: Fibrosis, a severe complication of metabolic-associated fatty liver disease, represents a major concern in the disease progression. Although liver biopsy remains the gold standard for fibrosis diagnosis, its invasive nature and high cost highlight the need for reliable noninvasive alternatives. Aim: To develop a simple, noninvasive fibrosis risk score based on clinical and biochemical variables in a Mexican population. Methods: A total of 295 participants from the Health Workers Cohort Study were included. Fibrosis was assessed using transient elastography (FibroScan), which served as the reference standard for the development and validation of the risk score. Participants were classified according to the Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) system. Diagnostic performance of candidate predictors was evaluated using receiver operating characteristic (ROC) curve analysis, and optimal cutoffs for fibrosis detection were identified. Results: The fibrosis risk score developed for the Mexican population, including sex, triglycerides, glucose, waist circumference, hypertension, high-density lipoprotein cholesterol, body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and insulin, achieved an area under the ROC (AUROC) of 81.1% (95% CI, 74.4, 87.8). In the subsample with available insulin measurements, the AUROC was comparable (79.8%; 95% CI: 72.9–86.8). When compared with existing fibrosis scores, including the BARD score (BMI, AST/ALT ratio, and type 2 diabetes) and the AST/ALT ratio, the newly developed score demonstrated superior diagnostic accuracy for fibrosis detection. Conclusions: This fibrosis risk score, based on routinely available clinical and biochemical data, demonstrated high diagnostic accuracy in a Mexican adult population. As a noninvasive tool, it may facilitate early identification of fibrosis in primary care settings and reduce the need for liver biopsy. Further validation in larger and more diverse populations is warranted.