Degree of Discordance Between FIB-4 and Transient Elastography: An Application of Current Guidelines on General Population Cohort
In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-...
Saved in:
| Published in: | Clinical gastroenterology and hepatology Vol. 22; no. 7; p. 1453 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
01.07.2024
|
| Subjects: | |
| ISSN: | 1542-7714, 1542-7714 |
| Online Access: | Get more information |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population.
Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement.
Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes.
Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies. |
|---|---|
| AbstractList | In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population.
Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement.
Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes.
Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies. In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population.BACKGROUND & AIMSIn the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population.Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement.METHODSUsing the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement.Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes.RESULTSAmong the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all P < .05). Misclassified subjects were also more likely to have prediabetes/diabetes.Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies.CONCLUSIONUsing FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies. |
| Author | Ghobrial, Mark Harrison, Stephen A Chang, Madeleine Kodali, Sudha Chang, Devon Noureddin, Mazen Alkhouri, Naim |
| Author_xml | – sequence: 1 givenname: Madeleine surname: Chang fullname: Chang, Madeleine organization: Arnold O. Beckman High School, Irvine, California – sequence: 2 givenname: Devon surname: Chang fullname: Chang, Devon organization: Arnold O. Beckman High School, Irvine, California – sequence: 3 givenname: Sudha surname: Kodali fullname: Kodali, Sudha organization: Houston Methodist, Houston, Texas – sequence: 4 givenname: Stephen A surname: Harrison fullname: Harrison, Stephen A organization: Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Pinnacle Research Center, San Antonio, Texas – sequence: 5 givenname: Mark surname: Ghobrial fullname: Ghobrial, Mark organization: Houston Methodist, Houston, Texas – sequence: 6 givenname: Naim surname: Alkhouri fullname: Alkhouri, Naim organization: Arizona Liver Health, Phoenix, Arizona – sequence: 7 givenname: Mazen surname: Noureddin fullname: Noureddin, Mazen email: noureddinmd@houstonresearchinstitute.com organization: Houston Methodist, Houston, Texas. Electronic address: noureddinmd@houstonresearchinstitute.com |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38428706$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkD1rwzAYhEVJaT7aH9ClaOxiV5JlW-6WOB8NBNohnY0iv04cFMmVbErG_vMmJIVOd3APB3dD1DPWAEKPlISU0ORlH6rtLmSE8ZCwkBBxgwY05ixIU8p7_3wfDb3fE8IynqV3qB8JzkRKkgH6mcLWAWBb4WntlXWlNArwBNpvAIPny0nAsTQlXjtpfA2mxTMtfWu3Tja74yseGzxuGl0r2dbWnHvyzrkzt-jqEnRtwONTsAADTmr8YZtOX9jc7qxr79FtJbWHh6uO0Od8ts7fgtX7YpmPV4HisWiDhMUZrViVAbCMcFVxGksBijMi04hWsiSJkiBIqmRWxvGmIklGBROl4hSEZCP0fOltnP3qwLfF4TQYtJYGbOcLlkWcJSKJyAl9uqLd5gBl0bj6IN2x-LuN_QJRUnJY |
| CitedBy_id | crossref_primary_10_1016_S0140_6736_24_01811_7 crossref_primary_10_1097_HEP_0000000000001356 crossref_primary_10_1111_liv_70281 crossref_primary_10_3390_diseases12070150 crossref_primary_10_1016_j_cgh_2025_02_018 crossref_primary_10_1007_s10620_024_08635_y crossref_primary_10_1007_s11739_024_03617_4 crossref_primary_10_1016_j_cgh_2025_02_014 crossref_primary_10_1053_j_gastro_2024_12_039 crossref_primary_10_1186_s12986_025_00927_y crossref_primary_10_1136_flgastro_2024_102705 crossref_primary_10_1016_j_cgh_2024_07_011 crossref_primary_10_1111_apt_18331 crossref_primary_10_1007_s10620_024_08668_3 crossref_primary_10_1111_apt_18346 crossref_primary_10_1016_j_cgh_2024_10_011 crossref_primary_10_1038_s41598_024_76560_1 crossref_primary_10_14309_ajg_0000000000003047 |
| ContentType | Journal Article |
| Copyright | Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/j.cgh.2024.02.008 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1542-7714 |
| ExternalDocumentID | 38428706 |
| Genre | Journal Article |
| GeographicLocations | United States |
| GeographicLocations_xml | – name: United States |
| GroupedDBID | --- --K .1- .FO 0R~ 1B1 1CY 1P~ 29B 4.4 457 53G 5GY 5VS AAEDT AAEDW AAFWJ AALRI AAQFI AAQQT AAXUO ABJNI ABLJU ABMAC ACGFS ADBBV AENEX AEVXI AFCTW AFJKZ AFRHN AFTJW AGCQF AITUG AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ APXCP BELOY C45 C5W CGR CS3 CUY CVF DU5 EBS ECM EFJIC EFKBS EIF EJD F5P FDB FRP HZ~ IHE KOM M41 MO0 N9A NPM NQ- O9- OBH OC. ON0 OVD P2P RIG ROL RPZ SEL SES TEORI UV1 XH2 Z5R 7X8 |
| ID | FETCH-LOGICAL-c458t-62591f2f9ee2904cf415a8ec420a731fad06cae807ca9d55bf0691828dc41e8a2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 21 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=001292836200001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1542-7714 |
| IngestDate | Thu Oct 02 20:15:40 EDT 2025 Mon Jul 21 05:58:54 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 7 |
| Keywords | MASH NASH Noninvasive Test Steatosis |
| Language | English |
| License | Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c458t-62591f2f9ee2904cf415a8ec420a731fad06cae807ca9d55bf0691828dc41e8a2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 38428706 |
| PQID | 2934268630 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2934268630 pubmed_primary_38428706 |
| PublicationCentury | 2000 |
| PublicationDate | 2024-07-01 |
| PublicationDateYYYYMMDD | 2024-07-01 |
| PublicationDate_xml | – month: 07 year: 2024 text: 2024-07-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Clinical gastroenterology and hepatology |
| PublicationTitleAlternate | Clin Gastroenterol Hepatol |
| PublicationYear | 2024 |
| SSID | ssj0029497 |
| Score | 2.5347853 |
| Snippet | In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1453 |
| SubjectTerms | Adult Aged Cohort Studies Elasticity Imaging Techniques - methods Fatty Liver - diagnostic imaging Female Humans Liver - diagnostic imaging Liver - pathology Liver Cirrhosis - diagnostic imaging Male Middle Aged Nutrition Surveys Practice Guidelines as Topic Risk Assessment - methods Severity of Illness Index United States |
| Title | Degree of Discordance Between FIB-4 and Transient Elastography: An Application of Current Guidelines on General Population Cohort |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/38428706 https://www.proquest.com/docview/2934268630 |
| Volume | 22 |
| WOSCitedRecordID | wos001292836200001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV07T8MwELaAIsTC-1FeMhKrRRI7ic2CSh_A0KoDSN0i1zlDl6SQlp1_jh277YSExJLFSmT5Lr7v_J3vQ-gGQFCm8pQYLJsTlhhbcKkTItlYJSoeM0FlLTaRDgZ8NBJDf-BW-bLKxZ5Yb9R5qewZ-a0JSyaY8IQG99MPYlWjLLvqJTTWUYMaKGO9Oh0tWYRIMCeuEjOLIkO2YDXr-i71ZrmIiLmWnfx3hFlHmt7uf-e4h3Y8xsQt5xT7aA2KA7TV9yz6IfrugMmyAZcadyaVTT-t6fGDK9nCvecHwrAsclwHMnthEncNyJ757tZ3uFXg1or4tt_xbZ7w49y2zbKl9NgM-J7WeLhUCcPt8t0A_iP02uu-tJ-Il2IgisV8RmyWFOpIC4BIBExpE_clB8WiQKY01DIPEiWBB6mSIo_jsQ4SYVIXnisWApfRMdooygJOEbaXXyUY3KdBMBhrLhIVqVSFQBWIlDbR9WJxM-Pqlr-QBZTzKlstbxOdOAtlU9eTI6PcUbZnf3j7HG1bw7ui2wvU0OZHh0u0qb5mk-rzqvYh8xwM-z-qZ9IG |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Degree+of+Discordance+Between+FIB-4+and+Transient+Elastography%3A+An+Application+of+Current+Guidelines+on+General+Population+Cohort&rft.jtitle=Clinical+gastroenterology+and+hepatology&rft.au=Chang%2C+Madeleine&rft.au=Chang%2C+Devon&rft.au=Kodali%2C+Sudha&rft.au=Harrison%2C+Stephen+A&rft.date=2024-07-01&rft.issn=1542-7714&rft.eissn=1542-7714&rft.volume=22&rft.issue=7&rft.spage=1453&rft_id=info:doi/10.1016%2Fj.cgh.2024.02.008&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1542-7714&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1542-7714&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1542-7714&client=summon |