A Swedish team created a test that predicts severe liver disease years ahead. It could help doctors detect risk early using routine blood data.
A recent study from Karolinska Institutet, published in The BMJ, demonstrates that a simple blood test can forecast an individual’s likelihood of developing serious liver disease. This approach could soon be introduced in primary healthcare to help identify cirrhosis and liver cancer at earlier stages.
“These are diseases that are growing increasingly common and that have a poor prognosis if detected late,” says Rickard Strandberg, affiliated researcher at Karolinska Institutet’s Department of Medicine in Huddinge, who has developed the test with his departmental colleague Hannes Hagström. “Our method can predict the risk of severe liver disease within 10 years and is based on three simple routine blood tests.”
In collaboration with Finnish researchers, the Swedish team assessed the method’s accuracy in predicting severe liver disease. Their model, named CORE, was built using advanced statistical techniques and incorporates five key variables: age, sex, and the levels of three commonly tested liver enzymes (AST, ALT, and GGT), which are routinely measured during medical checkups.
Making screening accessible in primary care
The researchers aimed to create a practical tool for use in primary care settings, where most patients first seek help. A web-based calculator is already available for healthcare professionals at www.core-model.com.
“This is an important step towards being able to offer early screening for liver disease in primary care,” says principal investigator Hannes Hagström, adjunct professor at Karolinska Institutet’s Department of Medicine in Huddinge, and senior consultant at Karolinska University Hospital. “Drug treatment is now available, soon hopefully also in Sweden, for treating people at a high risk of developing liver diseases such as cirrhosis or liver cancer.”
The study analyzed health data from more than 480,000 Stockholm residents who underwent medical examinations between 1985 and 1996. Over a follow-up period of up to 30 years, approximately 1.5 percent of participants developed serious liver conditions, including cirrhosis and liver cancer, or required a liver transplant.
Highly accurate risk prediction
The CORE model proved highly accurate and was able to differentiate between people who either did or did not develop the disease in 88 per cent of cases, which is an improvement on the currently recommended FIB-4 method.
“Primary care hasn’t had the tools to detect the risk of severe liver disease in time,” says Professor Hagström. “FIB-4 is not suited for the general population and is less effective at predicting the future risk of severe liver disease.”
The model was also tested on two other population groups in Finland and the UK, where it again demonstrated a high accuracy in predicting this risk. The researchers make the point, however, that it needs to be further tested on groups at especially high risk, such as people with type 2 diabetes or obesity. They also recognize a need to integrate the model into medical records systems to facilitate its clinical use.
Reference: “Use of new CORE risk score to predict 10 year risk of liver cirrhosis in general population: population based cohort study” by Rickard Strandberg, Fredrik Åberg, Juho V Asteljoki, Panu K Luukkonen, Veikko Salomaa, Antti Jula, Annamari Lundqvist, Satu Männistö, Markus Perola, Mats Talbäck, Niklas Hammar and Hannes Hagström, 29 September 2025, BMJ.
DOI: 10.1136/bmj-2024-083182
Financed by the Swedish Research Council, Region Stockholm (CIMED), and the Swedish Cancer Society.
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