Clinically Significant Fibrosis Is Associated With Longitudinal Increases in Fibrosis-4 and Nonalcoholic Fatty Liver Disease Fibrosis Scores

• Published in: Clinical gastroenterology and hepatology Vol. 18; no. 3; pp. 710 - 718.e4
• Main Authors: Patel, Preya Janubhai, Cheng, Johnson Chieh-Yu, Banh, Xuan, Gracen, Lucy, Radford-Smith, Daniel, Hossain, Fabrina, Horsfall, Leigh Ula, Hayward, Kelly Lee, Williams, Suzanne, Johnson, Tracey, Brown, Nigel Neil, Saad, Nivene, Stuart, Katherine Anne, Russell, Anthony William, Valery, Patricia Casarolli, Clouston, Andrew Donald, Irvine, Katharine Margaret, Bernard, Anne, Powell, Elizabeth Ellen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: Fibrosis; Gastroenterology and Hepatology; Nonalcoholic Fatty Liver Disease; Noninvasive Biomarkers; Repeated Measurements; AST; NAFLD; LSM; ICC; ALT; Noninvasive Biomarkers; Repeated Measurements; Fibrosis; Nonalcoholic Fatty Liver Disease; CSF; FIB-4; NFS; HbA1c; ELF; BMI; alanine aminotransferase; clinically significant fibrosis; intraclass correlation coefficient; nonalcoholic fatty liver disease fibrosis score; liver stiffness measurement; body mass index; Fibrosis-4; aspartate aminotransferase; enhanced liver fibrosis; hemoglobin A1c
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2019.07.036

There is limited knowledge regarding the longitudinal utility of biomarkers of fibrosis, such as the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) or the fibrosis-4 score (FIB-4) score. We examined longitudinal changes in the NFS and the FIB-4 score in patients with NAFLD, with and without clinically significant fibrosis (CSF). We performed a retrospective study of 230 patients with NAFLD, collecting clinical and laboratory records to calculate NFS and FIB-4 scores at 6 monthly intervals for 5 years before hepatology assessment of fibrosis. Linear mixed models with random intercept and slope and adjusted for age at baseline were used to assess the progression of NFS and log-transformed FIB-4 scores over time in subjects with and without CSF, determined by liver stiffness measurements of 8.2 kPa or greater. Patients had a median of 11 (minimum, 10; maximum, 11) retrospective observations over a median time period of 5 years (minimum, 4.5 y; maximum, 5 y). Of patients with low baseline NFS and FIB-4 scores, 31.11% and 37.76%, respectively, had CSF at the time of hepatology assessment. There was a correlation between NFS and log10 FIB-4 over time (repeated measure r = 0.55; 95% CI, 0.52–0.59). The rate of increase in NFS and log10 FIB-4 was significantly higher in patients with than without CSF (both P < .001). Predicted NFS increased by 0.17 and 0.06 units per year in subjects with and without CSF, respectively. Predicted log10 FIB-4 score increased by 0.032 and 0.0003 units per year in subjects with and without CSF, respectively. Noninvasively measured fibrosis scores increase progressively in patients with NAFLD and CSF. Further studies are needed to determine whether repeated measurements can identify patients at risk for CSF.