Steatosis-associated fibrosis estimator (SAFE) score in Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD)

Abstract

Abstract Background & Aims: Recently, steatosis-associated fibrosis estimator (SAFE) score has been developed for predicting significant fibrosis in primary car. We externally validated the SAFE score in Asian patients with MASLD. Approach & Results: We validated the SAFE score in 6,229 patients who underwent transient elastography (TE) between 2012 to 2022. The sensitivities, specificities, negative predictive values, and positive predictive values of SAFE scores (two cut-offs: <0 and ≥ 100) for predicting fibrosis stage ≥ 2 were calculated. Based on TE results, SAFE score had an area under the receiver operating characteristic curve of 0.753 (95% confidence interval [CI] 0.737–0.769), outperforming the fibrosis-4 index (0.672) and NAFLD fibrosis score (0.663). Non-obese and obese patients had similar sensitivities (77.0% vs. 78.4%) and specificities (61.5% vs. 51.8%) for SAFE score < 0, and similar sensitivities (50.0% vs. 50.0%) and specificities (90.1% vs. 85.4%) for SAFE score ≥ 100. Sensitivity of the SAFE score for ≥ 100 increased by age, from 16.1% (age 19–30) to 79.7% (age ≥ 61), whereas specificity for ≥ 100 showed a decreasing trend. Conclusions We externally validated good performance of SAFE score in Asian patients. The SAFE score has potential as an initial assessment to identify low-risk population in a primary care setting.