The association between liver fibrosis score and incident dementia: A nationwide retrospective cohort study

Abstract

Background: We assessed the relationship of liver fibrosis score with incident dementia in a large, national sample.

Methods: For this retrospective cohort study, data of dementia-free individuals aged 40-69 years were derived from electronic records of the largest healthcare provider in Israel. The association between liver fibrosis score (FIB-4), assessed from routine laboratory measurements, and incident dementia was explored through multivariate cox regression models.

Results: Of the total sample (N = 826,578, mean age 55 ± 8 years at baseline), 636,967 (77%) had no fibrosis, 180,114 (21.8%) had inconclusive fibrosis status and 9497 (1.2%) had high risk for advanced fibrosis. Over a median follow-up of 17 years, 41,089 dementia cases were recorded. Inconclusive liver fibrosis and advanced fibrosis were associated with increased dementia risk (HR = 1.09, 95%CI: 1.07-1.11 and HR = 1.18, 95%CI: 1.10-1.27, respectively). This association remained robust through seven sensitivity analyses.

Conclusions: Liver fibrosis assessed through a serum-based algorithm may serve as a risk factor for dementia in the general population.

Highlights: Liver fibrosis may predict dementia diagnosis in the general population. Inconclusive liver fibrosis was associated with 9% increased dementia risk. Advanced liver fibrosis was associated with 18% increased dementia risk. Findings remained robust in sensitivity analyses and after adjustments.

Keywords: cohort study; dementia; liver fibrosis; risk factors.

FIGURE 1

Flow diagram of study sample.

FIGURE 2

Kaplan–Meier curves for cumulative risk of dementia by liver fibrosis status.