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

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

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Humans
  • Liver Cirrhosis* / complications
  • Liver Cirrhosis* / diagnosis
  • Liver Cirrhosis* / epidemiology
  • Primary Health Care
  • Retrospective Studies
  • Severity of Illness Index
  • Transaminases*

Substances

  • Transaminases