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. 2022 Oct;37(13):3266-3274.
doi: 10.1007/s11606-021-07341-z. Epub 2022 Jan 19.

The Association of Fibrosis-4 Index Scores with Severe Liver Outcomes in Primary Care

Andrew D Schreiner  1 , William P Moran  2 , Jingwen Zhang  2 , Sherry Livingston  3 , Justin Marsden  2 , Patrick D Mauldin  2 , David Koch  2 , Mulugeta Gebregziabher  3
Affiliations

The Association of Fibrosis-4 Index Scores with Severe Liver Outcomes in Primary Care

Andrew D Schreiner et al. J Gen Intern Med. 2022 Oct.

Abstract

Background: The Fibrosis-4 Index (FIB-4)non-invasively assesses fibrosis risk in chronic liver disease (CLD), but underdiagnosis limits FIB-4's application in primary care.

Objective: To evaluate the association of FIB-4 risk with hazard of severe liver outcomes in primary care patients with and without diagnosed CLD.

Design: Retrospective cohort study of primary care data from 2007 to 2018.

Participants: Adult patients with qualifying aminotransferase and platelet count results were included and a single FIB-4 score was calculated for each patient using the first of these values. Patients with a CLD diagnosis or outcome prior to their FIB-4 score were excluded.

Measures: 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, liver transplantation, and hepatocellular carcinoma. We analyzed the association of FIB-4 risk categories with hazard risk of a severe liver outcome using stratified Cox regression models, stratifying patients by known CLD.

Key results: A total of 20,556 patients were followed for a mean 2,978 days (SD 1,201 days), and 4% of patients experienced a severe liver outcome. Of patients with low-, indeterminate-, and high-risk FIB-4 scores, 2%, 4%, and 20% suffered a severe liver outcome, respectively. In the overall adjusted model, high-risk FIB-4 scores were associated with hazard of severe liver disease (HR 6.64; 95% CI 5.58-7.90). High-risk FIB-4 scores were associated with severe liver outcomes for patients with known NAFLD (HR 7.32; 95% CI 3.44-15.58), other liver disease (HR 11.39; 95% CI 8.53-15.20), and no known CLD (HR 4.05; 95% CI 3.10-5.28).

Conclusions: High-risk FIB-4 scores were strongly associated with risk of severe liver outcomes in patients with and without known CLD. Comprehensive FIB-4 application in primary care may signal silently advancing liver fibrosis.

Keywords: Chronic liver disease; FIB-4; NAFLD.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of patients included in the study
Fig. 2
Fig. 2
Kaplan-Meier curve for severe liver disease risk-free survival by FIB-4 risk category for the entire sample
Fig. 3
Fig. 3
Kaplan-Meier curves for the severe liver disease risk-free survival by FIB-4 risk category stratified by chronic liver disease: a) no known chronic liver disease (None); b) nonalcoholic fatty liver disease (NAFLD); c) other liver disease diagnosis (Other Liver Dx); and d) known NAFLD and another chronic liver disease (NAFLD + Other Liver Dx)
See this image and copyright information in PMC

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