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Next week, >10,000 Fatty Liver stakeholders are expected to journey to London (rail strike and all) for the International Liver Congress (#ILC2022), the first meeting at this level since the pandemic started to include an in-person attendance option. This week, NASH Tsunami identifies some of the most important and intriguing non-embargoed presentations at #ILC2022. This conversation focuses largely on OS025 Non-invasive fibrosis scores as prognostic biomarkers of liver events, cardiovascular events and all-cause mortality in people with obesity and/or type 2 diabetes in the UK: a longitudinal cohort study, from Quentin Anstee (UK).

Stephen introduces this paper as one he found exceptionally important. He points out that the link from FIB-4 to major liver-associated outcomes (MALO) is not particularly novel, but the effort to link FIB-4 scores to MACE (cardiovascular events) and all-cause mortality is unique. In this case, the study tracked >45,000 patients with obesity or Type 2 diabetes plus a fibrosis score of F1 or higher for a ten-year period, over which time they observed almost 1,000 liver events, all either cirrhosis or events tied to cirrhosis. When tabulating these events against FIB-4 level, the researchers found 1% in the "low" group (FIB-4 2.45). 

The picture changes in interesting ways when looking at CVD and all-cause mortality. The percentages for CVD mortality were 11% for low, 27% for intermediate and 33% for high. For all-cause mortality, the numbers were 13%, 37% and 61% respectively. Stephen notes that FIB-4 looks like a more valuable test when measured against real-world endpoints instead of biopsy, which he describes as the "bronze standard."

Roger joins the conversation to look at these results from a primary care patient screening perspective. He notes that for CVD mortality, the indeterminate score was almost as good as high for predicting 10-year outcomes, and it was significantly better than the low score for all-cause mortality. He suggests that these numbers provide a strong case for integrating FIB-4 into primary screening for all obese or diabetic patients, as some guidelines are beginning to recommend. 

Louise goes on to consider the 10-year outcomes in the context of how much juvenile obesity and Type 2 diabetes we are beginning to see in population assessments and suggests that there results forebode declines in longevity, health and quality-of-life in the years to come. 

After Stephen notes that there are some excellent clinical trial presentations in #ILC2022 (but these are embargoed), each Surfer picks one session that intrigues them. Stephen looks at the Wednesday morning "think tank" titled "Think Tank on Risk Stratification and Drug Development." Jörn selects the Friday morning joint EASL-EASD session titled "One or many fatty liver diseases? Clinical impact of disease heterogeneity." Louise selects Saturday's Public Health session and Roger selects an abstract session from Saturday morning titled, "NAFLD: Diagnostics and non-invasive assessment."