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This study presents a machine learning-based clinical decision support system designed to assess the risk of hepatic fibrosis in patients with NAFLD using routine laboratory tests. The framework is developed using electronic health record data collected over 15\u2009years, initially encompassing 1,272,572 patients from general practice. After applying clinical selection criteria, two cohorts of 12,960 and 25,478 patients were used for model development and evaluation. The proposed approach provides a robust foundation for monitoring fibrosis risk by implementing a novel screening method, which preprocesses predictors by leveraging well-established clinical indicators (e.g., hepatic steatosis index, fibrosis-4 index), alongside a selected minimal number of predictors, making it practical and cost-effective for widespread clinical use. The study\u2019s findings indicate promising results for screening and monitoring fibrosis risk in NAFLD patients, achieving the best AUC of 92.97%, PRAUC of 75.44%, and Sensitivity of 79.63%.<\/jats:p>","DOI":"10.1145\/3788673","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:37:56Z","timestamp":1768833476000},"page":"1-28","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine Learning-Based Clinical Decision Support System for Hepatic Fibrosis Risk Prediction in General Practice"],"prefix":"10.1145","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4035-1115","authenticated-orcid":false,"given":"Michele","family":"Bernardini","sequence":"first","affiliation":[{"name":"Department of Information Engineering, Universit\u00e0 Politecnica delle Marche, Ancona, Italy and Department of Theoretical and Applied Sciences, eCampus University, Novedrate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0269-4304","authenticated-orcid":false,"given":"Mariachiara","family":"di Cosmo","sequence":"additional","affiliation":[{"name":"Department of Information Engineering, Universit\u00e0 Politecnica delle Marche, Ancona, Italy and Department of Innovative Technologies in Medicine and Dentistry, Universit\u00e0 degli Studi \u201cG. d\u2019Annunzio\u201d di Chieti-Pescara, Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-4499","authenticated-orcid":false,"given":"Gaia","family":"Barone","sequence":"additional","affiliation":[{"name":"National College of Ireland, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1707-0147","authenticated-orcid":false,"given":"Luca","family":"Romeo","sequence":"additional","affiliation":[{"name":"Department of Economics and Law, Universit\u00e0 di Macerata, Macerata, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8893-9244","authenticated-orcid":false,"given":"Emanuele","family":"Frontoni","sequence":"additional","affiliation":[{"name":"Department of Political Sciences, Communication and International Relations, Universit\u00e0 degli Studi di Macerata, Macerata, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"320","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2010.06612.x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm10020021"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2196\/medinform.8960"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v9.i16.715"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2023.107188"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1109\/JBHI.2021.3074206"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2021.3127274"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-06998-8"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1641221"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078378"},{"key":"e_1_3_3_13_2","unstructured":"EU. 2019. 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