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Background The aMAP score (based on age, sex, albumin, bilirubin, and platelets), risk stratifies patients into low (0–49.9), medium (50–59.9) or high-risk (≥60) of developing hepatocellular carcinoma (HCC) over 5 years. It was primarily developed in patients with viral hepatitis with steatotic liver disease (SLD) largely under-represented in its validation; we aimed to evaluate its utility in our regional Southwest UK population.Methods Retrospective review of the aMAP scores of patients diagnosed with HCC in the Bristol regional HPB MDT between June 2020-July 2023, and 3 and 5-years preceding diagnosis. Comparison was made between patients with SLD and chronic viral hepatitis using the Chi-square statistic (Chi2); patients with medium and low-risk scores were compared to those with a high-risk score.Results 134 patients (114 males; 85%; median age 70 years (IQR 13)) diagnosed with HCC at the regional HPB MDT.73 patients (54%) had underlying SLD (33 ARLD; 35 MASLD; 5 MetALD) and 27 (20%) with chronic hepatitis B (HBV; n=4) or C (HCV; n=23).At HCC diagnosis, 75% (n=101) had a high-risk aMAP score (median 64, (IQR 9)). 28 (21%) and 5 (4%) patients had medium-risk and low-risk scores respectively. Of the low-risk scores, 4 were female.73 patients (median 63, (IQR 8)) had 3-year historic aMAP scores; 40 (55%) had underlying SLD and 14 (19%) chronic viral hepatitis. 75% (n=55) had high-risk and 25% (n=18) medium-risk scores.57 patients (median 61, (IQR 8)) had 5-year historic aMAP scores with 67% (n=38) high-risk; 28 patients (49%) had underlying SLD and 13 (23%) chronic viral hepatitis. Only 1 patient (female, HCV) had a low risk aMAP score.Differences between aetiology of liver disease and aMAP scores were evaluated; SLD was associated with a higher median aMAP score (66) at HCC diagnosis compared to patients with chronic viral hepatitis (median aMAP score 66 vs 61; p=0.003, Chi2 8.475) and at 3-years preceding HCC diagnosis (median aMAP score 65 v 61; p=0.015, Chi2 5.89) respectively. There was no association at 5-years preceding HCC diagnosis (median aMAP score 63 v 60; p=0.176, Chi2 1.83) between patients with SLD and chronic viral hepatitis.Conclusion Patients with SLD had a higher median aMAP score at diagnosis and 3-years preceding HCC diagnosis compared to patients with chronic viral hepatitis. Our data adds to the growing evidence of the appropriate use of aMAP in a western population, where patients with SLD predominates to help in HCC risk-stratification.References Burke, et al. Hepatocellular carcinoma risk scores for non-viral liver disease: a systematic review and meta-analysis. J Hepatol. 2024;7(1):101227.doi:10.1016/j.jhepr.2024.101227European Association for the Study of the Liver EASL Policy Statement: risk-based surveillance for hepatocellular carcinoma among patients with cirrhosis. 2023. 2023. Available at: https://easl.eu/publication/easl-policy-statement-risk-basedFan, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol. 2020;73(6):1368–1378. doi:10.1016/j.jhep.2020.07.025