Liver cirrhosis: Repeat FIB-4 test predicts who’s at risk

A repeat fibrosis-4 (FIB-4) test ably identifies individuals at greatest risk for liver cirrhosis in a new study.

The FIB-4 test is used to noninvasively calculate the risk for hepatic fibrosis on account of a person’s age, transaminase level, and platelet count. Not only is the test widely available, it is also affordable. However, until this study it was never predictive of cirrhosis.

“What we’ve found was that done repeatedly, this test can improve prediction capacity to identify who will develop cirrhosis of the liver later in life,” said lead researcher Dr Hannes Hagström from the Karolinska University Hospital in Stockholm, Sweden. A FIB-4 score that rises from one test to the next indicates increased risk for severe liver disease. A score that drops indicates a reduced risk, he offered. [ILC 2020, abstract AS096]

Severe liver disease in high-risk groups

Hagström and team analysed 812,073 blood tests performed from 1985 –1996 of individuals enrolled in the Swedish Apolipoprotein Mortality Risk (AMORIS) study. Of these,  40,729 had two FIB-4 measurements taken <5 years apart and were included in the analysis. Test results were categorized into risk groups: low (<1.30), intermediate (1.30 - 2.67), and high (>2.67).

Those younger than 35 years or older than 79 years with a diagnosis of any liver disease were excluded. This is because the score has been shown to be less reliable in younger and older patients.

After a median of 16.2 years, 11,929 patients in the cohort had died and 581 had developed a severe liver disease.

Severe liver disease events were more common in those who had both tests categorized as high risk compared with individuals who had both tests categorized as low risk (13.2 percent  vs 1.0 percent; adjHR, 17.04, 95 percent confidence interval [CI], 11.67–24.88).

Each one-unit increase between the two test results was predictive of a severe liver disease event (adjHR, 1.81, 95 percent CI, 1.67–1.96).

The absolute risk for severe liver disease in the general population is two percent. However, the FIB-4 score is elevated in about one-third of those in the general population.

Why not a second test?

Although two FIB-4 scores might not accurately identify everyone who will develop cirrhosis, comparing the scores provides insight into who is at greatest risk, said Hagström. “This information can be useful, particularly for primary care doctors. If you know that your patient is at higher risk, you can send her for a FibroScan, which is a much more sensitive measurement, yet [it] is also more expensive. Now, we know better who to send,” he added.

If the first test offers poor prediction, a higher score on the second offers an opportunity for patient conversation, he concluded.