Sung Ki-Chul, Johnston Michael P, Lee Mi Y, Byrne Christopher D
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Liver Int. 2020 Jun;40(6):1303-1315. doi: 10.1111/liv.14416. Epub 2020 Mar 17.
BACKGROUND & AIMS: In a general population without known liver disease, we tested whether: (a) increased liver fibrosis scores (FIB-4 and APRI) are associated with liver cancer mortality and (b) the probability that a person with a higher score died of liver cancer.
In a retrospective occupational cohort who underwent annual/biennial health examinations (between 2002 and 2015), subjects were excluded with known chronic liver disease. Based on their baseline FIB-4 and APRI scores, subjects were categorised in low-/intermediate-/high-risk groups for advanced liver fibrosis. Using Cox proportional hazards regression analyses adjusted hazard ratios (aHR) were estimated for liver cancer mortality, with the low-risk FIB-4/APRI group as the reference. Harrell's C statistics were also calculated.
In 200 479 participants, mean (SD) age was 36.4 (7.7) years. Median follow-up was 4.1 years (IQR 2.10-8.03) with 80 liver cancer deaths. High baseline FIB-4 or APRI scores occurred in 0.25% and 0.09% of subjects respectively. A high FIB-4 or APRI score was associated with a markedly increased risk of liver cancer mortality (aHRs 629.10 [95% CI 228.74-1730.20] and 80.42 [95% CI 34.37-188.18]) respectively. C statistics were FIB-4 = 0.841 (95% CI 0.735-0.946) and APRI = 0.933 (95% CI 0.864-0.999).
In a general population without known liver disease, high FIB-4 or high APRI (in keeping with a high probability of advanced fibrosis) occurred in 0.25% (FIB-4) and 0.09% (APRI) of subjects. Both scores were associated with a markedly increased risk of liver cancer mortality and FIB-4 and APRI models both strongly predicted liver cancer mortality.
在无已知肝病的普通人群中，我们测试了：(a) 肝纤维化评分升高（FIB-4 和 APRI）是否与肝癌死亡率相关，以及 (b) 评分较高者死于肝癌的概率。
在一个接受年度/两年一次健康检查（2002 年至 2015 年期间）的回顾性职业队列中，排除已知患有慢性肝病的受试者。根据其基线 FIB-4 和 APRI 评分，将受试者分为晚期肝纤维化低/中/高风险组。使用 Cox 比例风险回归分析估计肝癌死亡率的调整风险比（aHR），以低风险 FIB-4/APRI 组作为对照。还计算了 Harrell's C 统计量。
在 200479 名参与者中，平均（标准差）年龄为 36.4（7.7）岁。中位随访时间为 4.1 年（四分位间距 2.10 - 8.03），有 80 例肝癌死亡。分别有 0.25%和 0.09%的受试者基线 FIB-4 或 APRI 评分较高。高 FIB-4 或 APRI 评分分别与肝癌死亡率显著增加相关（aHR 分别为 629.10 [95%置信区间 228.74 - 1730.20] 和 80.42 [95%置信区间 34.37 - 188.18]）。C 统计量为 FIB-4 = 0.841（95%置信区间 0.735 - 0.946）和 APRI = 0.933（95%置信区间 0.864 - 0.999）。
在无已知肝病的普通人群中，分别有 0.25%（FIB-4）和 0.09%（APRI）的受试者 FIB-4 或 APRI 较高（表明晚期纤维化可能性大）。两种评分均与肝癌死亡率显著增加相关，且 FIB-4 和 APRI 模型均强烈预测肝癌死亡率。
