Arnold O. Beckman High School, Irvine, California.
Houston Methodist, Houston, Texas.
Clin Gastroenterol Hepatol. 2024 Jul;22(7):1453-1461.e2. doi: 10.1016/j.cgh.2024.02.008. Epub 2024 Feb 29.
BACKGROUND & AIMS: In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population.
Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement.
Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes.
Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies.
在美国胃肠病学会/美国肝病研究学会（AGA/AASLD）临床护理路径中，纤维化-4 指数（FIB-4）用于对代谢功能障碍相关脂肪性肝病（MASLD）风险患者进行分层，分为发生进展性肝纤维化的低危、不确定风险或高危。我们评估了 FIB-4 在一般人群中的表现。
使用 2017 年至 2020 年全国健康和营养调查数据集，我们选择了≥18 岁且有 FibroScan 数据的受试者。我们遵循 AGA/AASLD 指南，确定了具有 MASLD 相关肝纤维化风险特征的受试者。排除了其他肝病的原因。我们的最终队列有 3741 名受试者。然后，我们根据推荐的 FIB-4 截止值对这些受试者进行分类。FibroScan 肝脏硬度测量（LSM）作为结局测量。
在 2776 名（74.2%）FIB-4 低危分类的受试者中，277 名（10%）未被 LSM 归类为低危，75 名（2.7%）被 LSM 归类为高危。在 86 名 FIB-4 高危分类的受试者中，68 名（79.1%）未被 LSM 归类为高危，54 名（62.8%）被 LSM 归类为低危。FIB-4 低危分类错误的受试者年龄较大；体重指数、腰围、糖化血红蛋白水平、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、舒张压、受控衰减参数评分、白细胞计数、碱性磷酸酶和空腹血糖水平较高；但高密度脂蛋白和白蛋白水平较低（均 P <.05）。分类错误的受试者更有可能患有糖尿病前期/糖尿病。
使用 AGA/AASLD 指南中的 FIB-4 对 MASLD 相关纤维化风险患者进行风险分层，导致许多患者被错误分类为低危和高危类别。因此，在解释和/或替代策略方面，谨慎考虑可能是值得的。
