MASLD Follow-Up: Who Really Needs Repeat Fibrosis Assessment?: JAMA | September 2026
Clinical knowledge base written and curated by GastroAGI Team from primary medical literatureLast updated September 1, 2026
What Did the Study Find?
This large study compared 9 clinical risk scores in 853,131 adults with imaging-confirmed, noncirrhotic steatotic liver disease.
- Over 10 years, 3.96% developed cirrhosis and 0.35% developed HCC.
- The SAFE (Steatosis-Associated Fibrosis Estimator) score provided the greatest clinical net benefit for predicting future cirrhosis.
- A SAFE threshold of 29.5 corresponded to approximately 2.5% 10-year cirrhosis risk.
- The findings suggest SAFE could help identify patients who merit repeat elastography or additional fibrosis assessment.
- In contrast, currently available HCC risk scores provided limited clinical discrimination in patients without cirrhosis.
- The cohort was 93% male, limiting generalizability.
Why Does It Matter?
Repeated fibrosis testing for every patient with MASLD/SLD is resource-intensive. Risk-based reassessment could focus surveillance on patients most likely to progress.
GastroAGI Takeaway
The next step in MASLD may be deciding not only how to assess fibrosis—but when to reassess it. SAFE could help prioritize patients for repeat fibrosis evaluation while reducing unnecessary testing in lower-risk individuals. Importantly, these data do not support expanding routine HCC surveillance to noncirrhotic SLD based on current risk scores alone.
