Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing and disproportionately affects Hispanics. The LiverRisk Score (LRS), a non-invasive stratification tool, could enhance early identification of patients at risk for liver disease; however, it has not been validated in a large U.S. Veteran cohort with sufficient liver-related outcomes. Approach: We conducted a retrospective cohort study of Veterans Health Administration (VHA) patients from 1999–2023. Individuals with chronic liver disease, viral hepatitis, or missing LRS values were excluded using laboratory and ICD-10 data. Patients were classified into minimal (LRS <6), low (6–<10), medium (10–<15), and high-risk (≥15) categories. Outcomes included liver-related events, mortality, hepatocellular carcinoma (HCC), and C-statistics. Analyses used parametric/non-parametric methods and Cox proportional hazard models with competing risks, adjusting for missing data. Results: Among 170,998 Veterans (93% male; median age 60; 63% White), 71%, 26%, 2%, and 0.5% were classified as minimal, low, medium, and high-risk, respectively. Over 13.5 years median follow-up, 15,463 (9%) developed a liver-related event, 6,219 (3.6%) died of liver causes, and 640 (0.5%) developed HCC. C-statistics were 0.61 for events, 0.70 for mortality, and 0.71 for HCC. Accuracy was highest among Hispanic/Latino Veterans (mortality 0.77, 95% CI 0.73–0.81; HCC 0.82, 95% CI 0.75–0.90) versus non-Hispanic Whites (mortality 0.62, 95% CI 0.61–0.62). Conclusions: LRS effectively predicted liver-related events, mortality, and HCC in Veterans. Its integration into clinical alerts and lab reports could support proactive patient care and liver disease prevention.
Hernaez et al. (Mon,) studied this question.