Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Liver Int. 2023 Jan;43(1):170-179. doi: 10.1111/liv.15295. Epub 2022 May 26.
The Fibrosis-4 index (FIB-4) can reliably assess fibrosis risk in patients with chronic liver disease, and advanced fibrosis is associated with severe liver disease (SLD) outcomes. However, CLD is underdiagnosed in primary care. We examined the association between FIB-4 risk strata and the incidence of SLD preceding a CLD diagnosis while considering incident CLD diagnoses as competing risks.
Using primary care clinic data between 2007 and 2018, we identified patients with two FIB-4 scores and no liver disease diagnoses preceding the index FIB-4. Patients were followed from index FIB-4 until an incident SLD (a composite of cirrhosis, hepatocellular carcinoma or liver transplantation), CLD or were censored. Hazard ratios were computed using a Fine-Gray competing risk model.
Of 20 556 patients, there were 54.8% in the low, 34.8% in the indeterminate, 6.6% in the high and 3.8% in the persistently high-risk FIB-4 strata. During a mean 8.2 years of follow-up, 837 (4.1%) patients experienced an SLD outcome and 11.5% of the sample received a CLD diagnosis. Of patients with an SLD event, 49% received no preceding CLD diagnosis. In the adjusted Fine-Gray model, the indeterminate (HR 1.41, 95% CI 1.17-1.71), high (HR 4.65, 95% CI 3.76-5.76) and persistently high-risk (HR 7.60, 95% CI 6.04-9.57) FIB-4 risk strata were associated with a higher incidence of SLD compared to the low-risk stratum.
FIB-4 scores with indeterminate- and high-risk values are associated with an increased incidence of SLD in primary care patients without known CLD.
纤维化 4 指数（FIB-4）可可靠地评估慢性肝病患者的纤维化风险，且晚期纤维化与严重肝脏疾病（SLD）结局相关。然而，初级保健中慢性肝病的诊断不足。我们在考虑到新发慢性肝病（CLD）诊断为竞争风险的情况下，研究了 FIB-4 风险分层与 SLD 发生率之间的关联，而 SLD 是在 CLD 诊断之前发生的。
我们使用 2007 年至 2018 年的初级保健诊所数据，确定了在进行 FIB-4 指数检查前有两次 FIB-4 评分且无肝脏疾病诊断的患者。从 FIB-4 指数检查开始，对患者进行随访，直至发生 SLD（肝硬化、肝细胞癌或肝移植的复合终点）、CLD 或截止。使用 Fine-Gray 竞争风险模型计算风险比。
在 20556 例患者中，低风险患者占 54.8%，不确定风险患者占 34.8%，高风险患者占 6.6%，持续高风险患者占 3.8%。在平均 8.2 年的随访期间，837 例（4.1%）患者发生了 SLD 结局，11.5%的样本诊断为 CLD。在发生 SLD 事件的患者中，49%的患者没有之前的 CLD 诊断。在调整后的 Fine-Gray 模型中，不确定风险（HR 1.41，95%CI 1.17-1.71）、高风险（HR 4.65，95%CI 3.76-5.76）和持续高风险（HR 7.60，95%CI 6.04-9.57）的 FIB-4 风险分层与低风险分层相比，发生 SLD 的发生率更高。
在无已知 CLD 的初级保健患者中，FIB-4 评分的不确定风险和高风险值与 SLD 发生率的增加相关。
