FIB-4 changes linked to risk of cirrhosis, HCC in NAFLD

Longitudinal changes in fibrosis-4 (FIB-4) score are strongly predictive of progression to cirrhosis and hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease (NAFLD), reveals a study.

A team of investigators conducted a retrospective cohort study of NAFLD patients from 130 Veterans Administration hospitals between 1 January 2004 and 31 December 2008, with follow-up on 31 December 2018. They calculated FIB-4 longitudinally and categorized patients based on advanced fibrosis risk: low risk FIB-4 <1.45, intermediate risk FIB-4 1.45‒2.67, high risk FIB-4 >2.67.

Landmark Fine-Gray competing risk models were used to determine the effects of FIB-4 changes between NAFLD diagnosis date and 3-year landmark time on the subsequent risk of HCC and a composite endpoint.

A total of 202,319 patients with NAFLD were included in the 3-year landmark analysis, of whom 473 progressed to HCC (incidence rate [IR], 0.28 per 1,000 person-years [PY], 95 percent confidence interval [CI], 0.26‒0.30). For the composite endpoint, the IR was 1.31 per 1,000 PY (95 percent CI, 1.25‒1.37).

At baseline, 74.7 percent of patients had low FIB-4, while 21.4 percent and 3.8 percent had intermediate and high FIB-4, respectively.

Patients with intermediate and high FIB-4, compared with those who were at stable low FIB-4 at both time points, had greater risks of HCC and the composite endpoint. Such risks were highest among patients with persistently high FIB-4 (HCC adjusted subdistribution hazard ratio [HR], 57.7, 95 percent CI, 40.5‒82.8; composite endpoint HR, 28.6, 95 percent CI, 24.6‒33.2).

“The FIB-4 score is a widely available noninvasive test for liver fibrosis, a primary determinant of the development of cirrhosis and HCC,” the investigators said. “Integrating serial measurements of noninvasive tests for fibrosis into the care pathway for patients with NAFLD could help tailor HCC risk prevention.”