Degree of Discordance Between FIB-4 and Transient Elastography: An Application of Current Guidelines on General Population Cohort

• Published in: Clinical gastroenterology and hepatology Vol. 22; no. 7; pp. 1453 - 1461.e2
• Main Authors: Chang, Madeleine, Chang, Devon, Kodali, Sudha, Harrison, Stephen A., Ghobrial, Mark, Alkhouri, Naim, Noureddin, Mazen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Adult; Aged; Cohort Studies; Elasticity Imaging Techniques - methods; Fatty Liver - diagnostic imaging; Female; Gastroenterology and Hepatology; Humans; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnostic imaging; Male; MASH; Middle Aged; NASH; Noninvasive Test; Nutrition Surveys; Practice Guidelines as Topic; Risk Assessment - methods; Severity of Illness Index; Steatosis; United States; United States; AST; IQR/M; aOR; CI; LSM; ALT; MASH; NASH; MASLD; Steatosis; HDL; CAP; VCTE; AASLD; WBC; FIB-4; NHANES; AGA; HbA1c; Noninvasive Test; BMI; high-density lipoprotein; adjusted odds ratio; alanine transaminase; liver stiffness measurement; white blood cell; interquartile range of liver stiffness to the median; body mass index; controlled attenuation parameter; vibration-controlled transient elastography; Fibrosis-4 index; metabolic dysfunction-associated steatotic liver disease; American Association for the Study of Liver Diseases; confidence interval; aspartate transaminase; hemoglobin A1c; National Health and Nutrition Examination Survey; American Gastroenterological Association
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2024.02.008

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. [Display omitted]