Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of ...Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of advanced liver disease in at-risk populations can enable timely intervention,prevent progression,and reduce complications.This review focuses on the current recommendations for early detection of advanced liver disease,evaluates the evidence for the performance of non-invasive tests in the target population for screening,and examines the multifaceted burden of screening,including economic implications and psychological impacts.Additionally,we discuss future directions,such as integrating liver health into a multidisciplinary care framework.Current guidelines recommend case-finding,targeting individuals with type 2 diabetes,metabolically complicated obesity,or persistent elevated liver enzymes.The Fibrosis-4 index is widely endorsed as a first-line non-invasive test,yet the diagnostic performance in primary care settings seems suboptimal,particularly for pre-cirrhotic disease.Sequential strategies incorporating novel non-invasive tests may improve accuracy and cost-effectiveness.Confirmation typically involves vibration-controlled transient elastography.Key challenges include a large eligible population,uncertainties in optimal screening intervals,patient adherence to follow-up,and limited real-world cost-effectiveness data.Integrating liver health assessment into cardiometabolic care pathways,reflex testing,telehealth,and patient education may enhance uptake.While challenges remain,early detection of advanced liver disease is already likely cost-effective.Ongoing advances in screening pathways and treatment options are expected to further strengthen the case for widespread implementation.展开更多
文摘Metabolic dysfunction-associated steatotic liver disease is the most prevalent chronic liver condition,affecting over one-third of the global population,with cirrhosis present in up to 3.3%of cases.Early detection of advanced liver disease in at-risk populations can enable timely intervention,prevent progression,and reduce complications.This review focuses on the current recommendations for early detection of advanced liver disease,evaluates the evidence for the performance of non-invasive tests in the target population for screening,and examines the multifaceted burden of screening,including economic implications and psychological impacts.Additionally,we discuss future directions,such as integrating liver health into a multidisciplinary care framework.Current guidelines recommend case-finding,targeting individuals with type 2 diabetes,metabolically complicated obesity,or persistent elevated liver enzymes.The Fibrosis-4 index is widely endorsed as a first-line non-invasive test,yet the diagnostic performance in primary care settings seems suboptimal,particularly for pre-cirrhotic disease.Sequential strategies incorporating novel non-invasive tests may improve accuracy and cost-effectiveness.Confirmation typically involves vibration-controlled transient elastography.Key challenges include a large eligible population,uncertainties in optimal screening intervals,patient adherence to follow-up,and limited real-world cost-effectiveness data.Integrating liver health assessment into cardiometabolic care pathways,reflex testing,telehealth,and patient education may enhance uptake.While challenges remain,early detection of advanced liver disease is already likely cost-effective.Ongoing advances in screening pathways and treatment options are expected to further strengthen the case for widespread implementation.
