Department of Internal Medicine and Liver Research Institute Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Gastroenterology Liver Center Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea.
Can J Gastroenterol Hepatol. 2024 Sep 16;2024:5667986. doi: 10.1155/2024/5667986. eCollection 2024.
This study aimed to examine whether repeated measurements on noninvasive fibrosis scores during follow-up improve long-term nonalcoholic fatty liver disease (NAFLD) outcome prediction.
A cohort study of 2,280 NAFLD patients diagnosed at the Seoul National University Hospital from 2001 to 2015 was conducted. Multivariable Cox regression models with baseline and designated time-point measurements of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) were used to assess the association between these scores and overall mortality, liver-related outcomes, and cardiovascular events.
Higher baseline NFS (high versus low probability for advanced fibrosis groups) was associated with higher risk of mortality (adjusted hazard ratio (aHR), (95% confidence interval (CI)), 2.80, [1.39-5.63]) and liver-related outcomes (3.70, [1.27-10.78]). Similar findings were observed for the association of baseline FIB-4 with mortality (2.49, [1.46-4.24]) and liver-related outcomes (11.50, [6.17-21.44]). In models considering designated time-point measurements of the scores, stronger associations were noted. For NFS, a higher time-point measurement was associated with a significantly higher risk of mortality (3.01, [1.65-5.49]) and liver-related outcomes (6.69, [2.62-17.06]). For FIB-4, higher time-point measurements were associated with significantly higher mortality (3.01, [1.88-4.82]) and liver-related outcomes (13.26, [6.89-25.53]). An annual increase in FIB-4 (2.70, [1.79-4.05]) or NFS (4.68, [1.52-14.44]) was associated with an increased risk of liver-related outcomes. No association between NFS/FIB-4 and risk of cardiovascular events was observed in both models.
Higher aHRs describing the associations of FIB-4/NFS with overall mortality and liver-related outcomes were observed in the models that included designated time-point measurements of the scores. In addition to the baseline measurement, a routine monitoring on these scores may be important in predicting prognosis of NAFLD patients.
本研究旨在探讨在随访期间对非侵入性纤维化评分进行重复测量是否能提高非酒精性脂肪性肝病（NAFLD）的长期预后预测能力。
本研究为 2001 年至 2015 年期间在首尔国立大学医院诊断为 NAFLD 的 2280 例患者的队列研究。使用多变量 Cox 回归模型，对纤维化 4 指数（FIB-4）和 NAFLD 纤维化评分（NFS）的基线和指定时间点测量值进行评估，以评估这些评分与总死亡率、肝脏相关结局和心血管事件之间的关系。
较高的基线 NFS（高级纤维化组与低概率纤维化组）与死亡率（调整后的危险比（aHR），（95%置信区间（CI）），2.80，[1.39-5.63]）和肝脏相关结局（3.70，[1.27-10.78]）的风险升高相关。同样，基线 FIB-4 与死亡率（2.49，[1.46-4.24]）和肝脏相关结局（11.50，[6.17-21.44]）之间的关联也存在类似的发现。在考虑评分的指定时间点测量值的模型中，观察到更强的关联。对于 NFS，较高的时间点测量值与死亡率（3.01，[1.65-5.49]）和肝脏相关结局（6.69，[2.62-17.06]）的风险显著升高相关。对于 FIB-4，较高的时间点测量值与死亡率（3.01，[1.88-4.82]）和肝脏相关结局（13.26，[6.89-25.53]）显著升高相关。FIB-4（每年增加 2.70，[1.79-4.05]）或 NFS（每年增加 4.68，[1.52-14.44]）的增加与肝脏相关结局的风险增加相关。在两个模型中均未观察到 NFS/FIB-4 与心血管事件风险之间的关联。
在包括评分指定时间点测量值的模型中，描述 FIB-4/NFS 与总死亡率和肝脏相关结局之间关系的 aHR 更高。除了基线测量值外，定期监测这些评分可能对预测 NAFLD 患者的预后很重要。
