Repeat FIB-4 tests boosts predictive ability for severe liver disease

Repeated tests improve the ability of the fibrosis-4 index (FIB-4) to determine people at risk of severe liver disease in the general population, a new study has shown.

The researchers used data from the population-based Swedish AMORIS cohort and determined incident liver disease by linking the population with national registries until 2011. Of the 126,942 individuals with available FIB-4 data, 32.1 percent (n=40,729) had measurements collected twice within 5 years and were eligible for the present analysis.

After the second test, participants had been followed for a median of 16.2 years, during which 581 severe liver disease episodes and 11,929 deaths were recorded. At the first test, the median FIB-4 result was 0.91, and most of the participants (77.8 percent) were deemed low-risk.

The median time between the first and second tests was 2.4 years. During this gap, around a quarter of participants saw a change in their risk classification. In the low-risk group, for example, 4,100 and 114 participants progressed to intermediate and high risk, respectively, by the second test.

Among the people who remained low-risk at both tests, 281 cases of severe liver disease were reported. Using this group as a reference, the risk of severe liver disease was found to be significantly elevated for all the other groups. The only exception was the intermediate-risk participants who were then reclassified as low-risk by the second test.

Notably, participants who were high-risk at both time points also saw the greatest risk estimate for severe liver disease (adjusted hazard ratio, 17.04, 95 percent confidence interval, 11.67–24.88).

In terms of test performance, the researchers found good predictive value, particularly for those who were high-risk at both tests, in whom the general accuracy was 98 percent.