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Multicenter Study
. 2023 Sep 22;7(10):e0244.
doi: 10.1097/HC9.0000000000000244. eCollection 2023 Oct 1.

Combination of Fibrosis-4, liver-stiffness measurement, and Fibroscan-AST score to predict liver-related outcomes in nonalcoholic fatty liver disease

Yu Jun Wong  1   2   3 , Esteban Urias  4 , Michael W Song  4 , Tanvi Goyal  4 , Wei Xuan Tay  3 , Nicole Xinrong Han  3 , Jing Hong Loo  3 , Tian Yu Qiu  1 , Karn Wijarnpreecha  5 , Yiong Huak Chan  6 , Vincent L Chen  4
Affiliations
Multicenter Study

Combination of Fibrosis-4, liver-stiffness measurement, and Fibroscan-AST score to predict liver-related outcomes in nonalcoholic fatty liver disease

Yu Jun Wong et al. Hepatol Commun. .

Abstract

Introduction: Noninvasive tests, such as Fibrosis-4 (FIB-4), liver-stiffness measurement (LSM) by vibration-controlled transient elastography, and Fibroscan-AST (FAST), are frequently used for risk stratification in NAFLD. The comparative performance of FIB-4 and LSM and FAST to predict clinical outcomes of patients with NAFLD remained unclear. We aim to evaluate the performance of FIB-4, LSM, and FAST scores to predict clinical outcomes in patients with NAFLD.

Methods: We included consecutive adult patients with NAFLD with transient elastography performed between 2015 and 2022 from the United States and Singapore. Patients with NAFLD stratified based on baseline FIB-4, LSM, and FAST score were followed up until clinical outcomes notably liver-related events (LREs), LREs or death, death, and major adverse cardiac events.

Results: A total of 1262 patients with NAFLD (63% with obesity and 37% with diabetes) with vibration-controlled transient elastography were followed up for median 3.5 years. FIB-4 stratified patients with NAFLD into low-risk (<1.3), intermediate-risk (1.3-2.67), and high-risk (>2.67) in 59.4%, 31.5%, and 9.1%, respectively. No LRE occurred with baseline FIB-4 <1.3, regardless of LSM and FAST score. Higher FIB-4 was associated with a higher risk of LREs within each LSM category. FIB-4 had a higher area under the received operating characteristic curve than LSM or FAST score to predict LRE.

Conclusions: In this multicenter international study, FIB-4 and LSM synergistically predicted the risk of LRE. In patients with FIB-4 <1.3, vibration-controlled transient elastography may incorrectly classify up to 10% of the patients as high risk. FIB-4 should be incorporated into risk stratification in NAFLD even among patients who underwent VCTE.

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Conflict of interest statement

Vincent L. Chen received grants from KOWA and AstraZeneca. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of liver-related events based on FIB-4, LSM, or FAST score. The 5-year cumulative incidence of liver-related event was higher among NAFLD patients with a high FIB-4 score, high LSM, or high FAST score. FIB-4, low (<1.3), intermediate (1.3–2.6), high (>2.6); LSM: low (<8 kPa), intermediate (8–12 kPa), high (>8 kPa); FAST: low (<0.35), intermediate: (0.35–0.67), high (>0.67). Abbreviations: FAST, Fibroscan-AST score; FIB-4, Fibrosis index of 4 factors; LRE, liver-related events; LSM, liver-stiffness measurement.
FIGURE 2
FIGURE 2
Time-dependent ROC curves for prediction of liver-related events, liver-related events/death, death, and major adverse cardiac events at 3 years using FIB-4, LSM, and FAST. Abbreviations: FAST, Fibroscan-AST score; FIB-4, Fibrosis index of 4 factors; LRE, liver-related events; LSM, liver-stiffness measurement.
See this image and copyright information in PMC

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