Zuluaga Paola, Fuster Daniel, Blanes Rafael, Hernández-Rubio Anna, Miquel Laia, Torrens Marta, Rubio Gabriel, Bolao Ferrán, Liangpunsakul Suthat, Abellí-Deulofeu Enric, Rodriguez de Fonseca Fernando, Muga Robert
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Spain.
Universitat Autònoma de Barcelona, Bellaterra, Spain.
Alcohol Clin Exp Res (Hoboken). 2024 Jul;48(7):1313-1321. doi: 10.1111/acer.15345. Epub 2024 May 8.
Effective screening for alcohol-associated liver disease is relevant in the context of chronic, excessive alcohol consumption. Patients with alcohol-associated liver disease are often not diagnosed until their liver disease is decompensated. We analyzed the prevalence and associations of Fibrosis-4 index (FIB-4) values suggestive of advanced liver fibrosis in patients referred for their first treatment of alcohol use disorder (AUD).
We conducted a cross-sectional, multicenter study of noncirrhotic individuals referred for their first AUD treatment between March 2013 and April 2021. We obtained sociodemographic data, substance use characteristics, and blood samples at admission. We considered a FIB-4 value ≥2.67 suggestive of advanced liver fibrosis and used logistic regression analyses to identify features associated with this value.
We included 604 patients (67% male), with a median age at admission of 48 years [IQR: 41-56 years]. The median duration of regular alcohol consumption was 21 years [IQR: 18-30 years] and the median alcohol consumption was 105 standard drink units (SDU)/week [IQR: 63-160 SDU/week]. A FIB-4 value ≥ 2.67 was present in 19.3% of cases. These patients reported more frequent binge drinking (75.4% vs. 66%, p = 0.05) than those with FIB-4 values below 2.67. In multivariate analysis, a history of binge drinking (OR 1.9, 95% CI, 1.05-3.47), anemia (OR 2.95, 95% CI, 1.42-6.11), leukopenia (OR 7.46, 95% CI, 2.07-26.8), and total serum bilirubin >1 mg/dL (OR 6.46, 95% CI, 3.57-11.7) were independently associated with FIB-4 values ≥2.67.
One in five patients admitted to treatment for AUD without evidence of decompensated liver disease have FIB-4 values suggestive of advanced liver fibrosis. The presence of a binge drinking history, anemia, leukopenia, and elevated bilirubin levels is associated with high FIB-4 values.
在慢性过量饮酒的背景下，有效筛查酒精相关性肝病具有重要意义。酒精相关性肝病患者往往直到肝病失代偿才被诊断出来。我们分析了首次因酒精使用障碍（AUD）接受治疗的患者中提示晚期肝纤维化的纤维化-4指数（FIB-4）值的患病率及其相关性。
我们对2013年3月至2021年4月期间首次因AUD接受治疗的非肝硬化个体进行了一项横断面多中心研究。我们在入院时获取了社会人口统计学数据、物质使用特征和血样。我们认为FIB-4值≥2.67提示晚期肝纤维化，并使用逻辑回归分析来确定与该值相关的特征。
我们纳入了604例患者（67%为男性），入院时的中位年龄为48岁[四分位间距（IQR）：41 - 56岁]。定期饮酒的中位持续时间为21年[IQR：18 - 30年]，中位酒精摄入量为105标准饮酒单位（SDU）/周[IQR：63 - 160 SDU/周]。19.3%的病例FIB-4值≥2.67。与FIB-4值低于2.67的患者相比，这些患者报告的暴饮频率更高（75.4%对66%，p = 0.05）。在多变量分析中，暴饮史（比值比[OR]1.9，95%置信区间[CI]，1.05 - 3.47）、贫血（OR 2.95，95% CI，1.42 - 6.11）、白细胞减少（OR 7.46，95% CI，2.07 - 26.8）和总血清胆红素>1mg/dL（OR 6.46，95% CI，3.57 - 11.7）与FIB-4值≥2.67独立相关。
在因AUD入院治疗且无肝病失代偿证据的患者中，五分之一的患者FIB-4值提示晚期肝纤维化。暴饮史、贫血、白细胞减少和胆红素水平升高与高FIB-4值相关。
