SAFE Score for Significant Fibrosis in NAFLD/MASLD
Steatosis-Associated Fibrosis Estimator (SAFE) score. Non-invasive tool to identify patients with NAFLD/MASLD who have significant or advanced liver fibrosis (F2-F4) requiring further investigation or specialist referral. Combines simple laboratory tests. Developed by Newsome et al. 2022 as an improvement over FIB-4 alone for the NAFLD/MASLD population. Lower threshold has high sensitivity for ruling out fibrosis.
Score interpretation
Rule-out of F ≥ 2 fibrosis (sensitivity > 90 %).
→ Manage metabolic risk factors; repeat in primary care.
Indeterminate for F ≥ 2 fibrosis.
→ Second-line test (e.g. elastography) per local pathway.
About 80 % specificity for F ≥ 2 fibrosis.
→ Refer to hepatology.
Interpretation bands for the SAFE Score. Apply clinical judgement and local guidance.
References
- Newsome PN et al. Development and validation of the SAFE score for NAFLD-related fibrosis. JHEP Rep. 2022;4(3):100426.
- NICE NG49. Non-alcoholic fatty liver disease (NAFLD): assessment and management. NICE. 2016 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- Amphotericin B (Liposomal) · Polyene Antifungal — Invasive Fungal Infections (Aspergillosis / Cryptococcosis / Candida)
- Anidulafungin · Echinocandin Antifungal — Invasive Candidiasis / Candidaemia
- Micafungin · Echinocandin Antifungal — Invasive Candidiasis / Prophylaxis in HSCT
- Intra-uterine contraceptive device (copper) · Long-acting reversible contraception (Cu-IUD)
- Ivacaftor · CFTR Potentiator (Cystic Fibrosis — Gating Mutations)
- Elexacaftor / Tezacaftor / Ivacaftor · CFTR Triple Modulator (Cystic Fibrosis — F508del)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.