Use of FIB-4 In Primary Care May Warn of Liver Fibrosis

Research presented at the American Association for the Study of Liver Diseases annual meeting showed a strong association between severe liver disease outcomes and high-risk scores on the Fibrosis-4 Index (FIB-4), even among patients who had no diagnosis of chronic liver ailments.

The study was presented by Andrew D. Schreiner, MD, from the Medical University of South Carolina in Charleston.

“The Fibrosis-4 Index (FIB-4) non-invasively assesses fibrosis risk in chronic liver disease, but underdiagnosis limits FIB-4’s application in primary care,” the authors reported. “This study evaluates the association of FIB-4 risk with severe liver outcomes in primary care patients with and without diagnosed chronic liver disease.”

The investigators conducted a retrospective cohort study of electronic health record data from primary care for the period 2007 to 2018. For each patient with qualifying aminotransferase results, the researchers calculated a single FIB-4 score, excluding those patients previously diagnosed with chronic liver disease diagnosis.

“FIB-4 advanced fibrosis risk categorization (low, indeterminate, and high) was the primary predictor variable. Patients were followed from FIB-4 score to a severe liver outcome, a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation,” the authors reported. “We analyzed the association of FIB-4 with hazard risk of a severe liver outcome using stratified Cox regression models, stratifying patients by chronic liver disease diagnoses made during follow-up.”

The researchers followed 20,556 patients for approximately 8.2 years, during which 4% (837) of patients experienced a severe liver outcome. They found that 13,127 (64%) of these patients were classified as low risk based on their FIB-4; 29% (6,012) were indeterminate-risk; and 7% (1,417) were high-risk for advanced fibrosis. Those who suffered a severe liver outcome included 2% of patients with a low-risk FIB-4; 4% of those with an indeterminate-risk score; and 20% of those with a high-risk FIB-4 score.

“During follow-up, 11% of the sample received a chronic liver disease diagnosis of the 837 patients with a severe liver outcome, and 411 (49%) had no chronic liver disease diagnoses prior to the severe liver event,” the authors stated. “In the overall adjusted model, high-risk FIB-4 scores were associated with hazard of severe liver disease (HR 6.54; 95% CI 5.49-7.77; Table 2). High-risk FIB-4 scores were associated with severe liver outcomes for patients with known NAFLD (HR 7.71; 95% CI 3.62-16.45), other liver disease (HR 11.12; 95% CI 8.33-14.82), and no known chronic liver disease (HR 4.04; 95% CI 3.10-5.28).”

The investigators concluded, “Comprehensive FIB-4 application in primary care may signal silently advancing liver fibrosis.”

--Rebecca Mashaw

Reference:

Schreiner AD, et al. The fibrosis-4 index and severe liver disease outcomes in primary care: a stratified Cox analysis. Presented at: Presented at: the American Association for the Study of Liver Disease annual meeting. November 12-15. Virtual.