Refined Fibrosis Screening Criteria Reduce Eligible Population, Improve Detection of Advanced Liver Disease

A refined fibrosis screening strategy substantially reduced the number of adults identified for screening while increasing the likelihood of detecting clinically significant liver fibrosis, according to an analysis of U.S. population data with validation across multiple international cohorts.

Current guideline-defined fibrosis screening recommendations identify a majority of adults as eligible for screening, creating challenges for health care resource allocation. Investigators sought to refine these criteria by targeting only population subgroups with at least a 10% risk of elevated liver stiffness measurement (LSM ≥8 kPa).

The derivation cohort included 5904 adults aged 18 to 80 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 with a body mass index of at least 18.5 kg/m² and no excessive alcohol use. Overall, 8.9% had an LSM of at least 8 kPa.

Current guideline recommendations identified 60% to 76% of adults as eligible for fibrosis screening, with an LSM of at least 8 kPa present in 11% to 14% of those screened. In contrast, the refined strategy reduced the screening-eligible population to 22% while increasing the prevalence of elevated LSM among eligible individuals to 28%. Among those not selected for screening, the prevalence of elevated LSM remained low at 4%.

The findings were confirmed in a pooled validation cohort of 13,295 participants. Only 14% met the refined screening criteria, while rates of LSM of at least 8, 10, and 12 kPa remained consistently higher among those selected for screening than those not selected.

Longitudinal analyses in 282,852 participants from the UK Biobank demonstrated that individuals meeting the refined criteria had approximately sixfold higher 10-year risks of both incident cirrhosis (0.99% vs 0.18%) and liver-related death (0.40% vs 0.07%).

The authors concluded that “current recommendations target 60%-76% of adults for fibrosis screening” while their refined strategy “reduced this to 10%-22%, achieving significantly higher disease prevalence among those eligible for screening, while maintaining a very low risk of increased LSM or liver-related events in those not eligible for screening.”

Reference
van Kleef LA, Pustjens J, Schneider CV, et al. Validated early detection metrics reduce the population requiring liver fibrosis screening. Gastroenterology. Published online June 15, 2026. doi:10.1053/j.gastro.2026.06.003