Software Helps Detect Clinically Significant Liver Fibrosis in Primary Care

A new software tool, LiverPRO, has demonstrated strong diagnostic and prognostic performance for identifying clinically significant liver fibrosis in patients with steatotic liver disease, according to a multicenter prospective study published in The Lancet Gastroenterology & Hepatology.

LiverPRO offers an accessible, adaptable approach for primary care providers to assess liver fibrosis and predict liver-related events, potentially streamlining referrals to hepatologists. 

The study involved 6 independent cohorts from Denmark, Germany, and England, including 9484 patients from primary and secondary care. Researchers used clinically significant fibrosis (histology stage ≥F2) and advanced fibrosis (≥F3) as outcomes to develop the tool with fractional polynomial regression. The diagnostic performance was validated against transient elastography thresholds (≥8 kPa and ≥12 kPa). 

In the DECIDE validation cohort (n=6,468), LiverPRO achieved an area under the receiver operating characteristic curve (AUC) of 0.80 for detecting transient elastography ≥8 kPa, comparable to enhanced liver fibrosis testing (AUC 0.78) and the LiverRisk score (AUC 0.81), while outperforming the Fibrosis-4 index (AUC 0.69) and the NAFLD Fibrosis Score (AUC 0.74). The tool also reliably predicted liver-related events, with a C-statistic of 0.80 at two years in the UK Biobank cohort. 

“LiverPRO diagnosed clinically significant fibrosis with good accuracy,” the authors reported, adding that it showed consistent performance across validation cohorts, albeit with slightly lower accuracy in smaller datasets. 

LiverPRO demonstrated high sensitivity and negative predictive value for ruling out fibrosis at a cutoff of <25%, with sensitivity of 80.6% and a negative predictive value of 98.0%. For ruling in fibrosis at a threshold >65%, specificity was 95.5%, with a positive predictive value of 33.0%. 

Adaptable to different liver blood test analytes, LiverPRO enables primary care clinicians to assess fibrosis without requiring extensive testing infrastructure. “LiverPRO reliably identifies clinically significant liver fibrosis and elevated liver stiffness,” the study concluded. The tool received European CE approval in 2024, marking its readiness for clinical implementation. 

Reference
Lindvig KP, Thorhauge KH, Hansen JK, et al. Development, validation, and prognostic evaluation of LiverPRO for the prediction of significant liver fibrosis in primary care: a prospective cohort study. Lancet Gastroenterol Hepatol. 2025;10(1):55-67. doi:10.1016/S2468-1253(24)00274-7