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-...

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Vydáno v:Clinical gastroenterology and hepatology Ročník 22; číslo 7; s. 1453
Hlavní autoři: Chang, Madeleine, Chang, Devon, Kodali, Sudha, Harrison, Stephen A, Ghobrial, Mark, Alkhouri, Naim, Noureddin, Mazen
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.07.2024
Témata:
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
United States
MASH
NASH
Noninvasive Test
Steatosis
ISSN:1542-7714, 1542-7714
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Shrnutí: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.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1542-7714
1542-7714
DOI:10.1016/j.cgh.2024.02.008