Validation of modified fibrosis-4 index for predicting hepatocellular carcinoma in patients with compensated alcoholic liver cirrhosis

Abstract

Recently, modified fibrosis-4 index (mFIB-4) and the easy liver fibrosis test (eLIFT) were developed for predicting liver fibrosis in chronic liver disease patients. We evaluated whether the 2 tests can predict hepatocellular carcinoma (HCC) risk in alcoholic liver cirrhosis (ALC) patients.A retrospective cohort of 924 ALC patients was assessed for HCC development. Four non-invasive serum biomarkers, mFIB-4, the eLIFT score, fibrosis-4 index (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) were tested using time-dependent analysis of areas under receiver operating characteristic curve (AUROC), DeLong, and log-rank tests.During a median 4.8 years of follow-up, HCC occurred in 83 patients (9.0%). For predicting HCC development at 3 years, the mFIB-4 showed a significantly higher AUROC than APRI and eLIFT scores (0.71 vs 0.61 and 0.56, respectively, all P < .05). The AUROCs of the mFIB-4 for HCC development were not significantly different from those of the FIB-4. According to the mFIB-4, the risk of HCC development was significantly stratified by low index (≤4)/high index (>4) (P < .001 by log-rank test).The mFIB-4 showed better predictability of HCC development than APRI and eLIFT scores, and significantly stratified HCC risk in Asian ALC patients.

Figure 1

Patient flowchart of this study.

Figure 2

Cumulative incidence rates of HCC development according to risk groups. (A) The AUROCs of the mFIB-4 index, FIB-4 index, APRI, and eLIFT score in predicting HCC development at 3 years were 0.71, 0.69, 0.61, and 0.56, respectively. (B) Patients with an mFIB-4 index >4 had a significantly higher HCC development than those with an mFIB-4 index ≤4 (P value < 0.001 by log-rank test). (C) Patients with a FIB-4 index >3.25 had a significantly higher HCC development than those with a FIB-4 index ≤3.25 (P = .003 by log-rank test). (D) Patients with APRI scores >1 had a significantly higher HCC development than those with a APRI scores ≤1 (P = .005 by log-rank test). (E) Patients with eLIFT scores ≤ 8 had a significantly higher HCC development than those with eLIFT scores > 8 (P = .01 by log-rank test). APRI = aspartate aminotransferase-to-platelet ratio index, AUROC = areas under receiver operating characteristics curves, eLIFT = easy liver fibrosis test, FIB-4 = fibrosis-4, HCC = hepatocellular carcinoma, mFIB-4 = modified Fibrosis-4.