The study sought to examine which biomarkers have the best predictive capabilities for future alcohol-related liver cirrhosis (ARLC) in a general population setting. This population-based cohort study includes approximately 35% of the inhabitants of Stockholm County who had left a blood sample at an outpatient visit in primary care or occupational health screening from 1985 to 1996. All subjects with a blood sample measurement of alanine aminotransferase and aspartate aminotransferase (AST) were included, exclusions were made for persons with known liver disease. We ascertained incident ARLC by linkage to Swedish national health registers between to the end of 2011. Associations between biomarkers and incident ARLC were analyzed with Cox regression models and discrimination was assessed using C-statistics. In all, 537,230 adult subjects were included. The mean age was 45 years and 53% were men. During a mean follow-up of 19.0 years, 2725 (0.51%) subjects developed ARLC. The biomarkers with the highest discrimination (C-index) for incident ARLC at 5 years were: AST (0.89), mean corpuscular volume (0.88), and γ-glutamyltransferase (0.81). Scoring systems including Fibrosis-4 (0.86) and the AST/alanine aminotransferase ratio (0.81) performed similarly well. The negative predictive value for ARLC was generally high (∼99.6%) across biomarkers, using routine clinical cutoffs to identify pathological values. However, positive predictive values were generally low (0.6%–15.9%). Biomarkers commonly used in primary care settings are highly associated with incident ARLC in the general population. Elevation of these commonly available biomarkers should prompt consideration of further investigation of a possible high level of alcohol consumption.

中文翻译：

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预测酒精相关性肝硬化的生物标志物：瑞典一项针对 537,250 人的一般人群研究


该研究旨在探讨哪些生物标志物对一般人群中未来酒精相关性肝硬化（ARLC）具有最佳预测能力。这项基于人群的队列研究包括大约 35% 的斯德哥尔摩县居民，他们在 1985 年至 1996 年间在初级保健或职业健康筛查门诊就诊时留下了血样。所有受试者的血样均测量了丙氨酸转氨酶和天冬氨酸水平包括转氨酶（AST），排除患有已知肝病的人。我们通过与 2011 年底之间瑞典国家健康登记册的联系来确定 ARLC 事件。使用 Cox 回归模型分析生物标志物和 ARLC 事件之间的关联，并使用 C 统计量评估歧视。总共包括 537,230 名成人受试者。平均年龄为 45 岁，其中 53% 为男性。在平均 19.0 年的随访期间，2725 名受试者 (0.51%) 出现了 ARLC。 5 年时 ARLC 发生率最高的生物标志物（C 指数）为：AST (0.89)、平均红细胞体积 (0.88) 和 γ-谷氨酰转移酶 (0.81)。包括 Fibrosis-4 (0.86) 和 AST/丙氨酸转氨酶比率 (0.81) 在内的评分系统表现同样出色。使用常规临床临界值来识别病理值，所有生物标志物的 ARLC 阴性预测值普遍较高（约 99.6%）。然而，阳性预测值普遍较低（0.6%–15.9%）。初级保健机构中常用的生物标志物与普通人群中 ARLC 事件高度相关。这些常见生物标志物的升高应促使考虑进一步调查可能的高水平饮酒。