Fukai Kota, Nakazawa Shoko, Sakai Kosuke, Furuya Yuko, Watanabe Yuya, Honda Toru, Hayashi Takeshi, Nakagawa Toru, Korenaga Masaaki, Tatemichi Masayuki
Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan.
Hitachi Health Care Center, Hitachi, Japan.
J Occup Health. 2025 Jan 7;67(1). doi: 10.1093/joccuh/uiaf038.
To examine the utility of the FIB-3 index as a secondary screening tool for liver fibrosis in workplace-based health checkups, by comparing its concordance and negative predictive values (NPVs) with those of the FIB-4 index.
This cross-sectional study included 12 622 workers from the Hitachi Cohort Study who underwent workplace-based health checkups between April 2021 and March 2022. FIB-4 was calculated using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, whereas FIB-3 used the same components except age. To evaluate the utility of FIB-3 in excluding liver fibrosis, NPVs were calculated using FIB-4 thresholds (1.30, 2.01, and 2.67) as references. Concordance between FIB-3 and FIB-4 was examined across different age groups. In addition, multivariate logistic regression analysis was conducted to identify factors associated with false-positive FIB-3 results.
The FIB-3 index demonstrated high NPVs for excluding liver fibrosis, with values of 99.9% at FIB-4 ≥ 1.30 and 98.2% at FIB-4 ≥ 2.67. Strong concordance between FIB-3 and FIB-4 was observed consistently across different age groups. Among participants with elevated ALT (>30 IU/L), FIB-3 consistently ruled out fibrosis, whereas FIB-4 positivity increased with advancing age. Multivariate analysis indicated that higher AST levels and increased alcohol intake were significantly associated with false-positive FIB-3 results.
The FIB-3 index demonstrated stable performance across age groups while maintaining high concordance and NPV relative to FIB-4. These findings suggest that FIB-3 may serve as a practical screening tool in routine workplace-based health checkups, particularly in mitigating age-related overestimation observed with the FIB-4 index.
通过比较FIB-3指数与FIB-4指数的一致性和阴性预测值（NPV），检验FIB-3指数作为工作场所健康检查中肝纤维化二级筛查工具的效用。
这项横断面研究纳入了来自日立队列研究的12622名工人，他们在2021年4月至2022年3月期间接受了工作场所健康检查。FIB-4通过年龄、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和血小板计数计算得出，而FIB-3使用除年龄外的相同成分。为评估FIB-3在排除肝纤维化方面的效用，以FIB-4阈值（1.30、2.01和2.67）为参考计算NPV。在不同年龄组中检查FIB-3与FIB-4之间的一致性。此外，进行多因素逻辑回归分析以确定与FIB-3假阳性结果相关的因素。
FIB-3指数在排除肝纤维化方面显示出较高的NPV，FIB-4≥1.30时为99.9%，FIB-4≥2.67时为98.2%。在不同年龄组中始终观察到FIB-3与FIB-4之间有很强的一致性。在ALT升高（>30 IU/L）的参与者中，FIB-3始终排除纤维化，而FIB-4阳性率随年龄增长而增加。多因素分析表明，较高的AST水平和饮酒量增加与FIB-3假阳性结果显著相关。
FIB-3指数在各年龄组中表现稳定，相对于FIB-4保持了较高的一致性和NPV。这些发现表明，FIB-3可作为常规工作场所健康检查中的实用筛查工具，特别是在减轻FIB-4指数所观察到的与年龄相关的高估方面。
