The following is a summary of the “Longitudinal changes in fibrosis markers are associated with risk of cirrhosis and hepatocellular carcinoma in non-alcoholic fatty liver disease,” published in the March 2023 issue of Gastroenterology by Cholankeril, et al.

Non-alcoholic fatty liver disease (NAFLD) fibrosis-4 (FIB-4) score alterations and their association with the eventual risk of cirrhosis and/or hepatocellular cancer (HCC) are not well understood at present. Therefore, we set out to determine if there was a correlation between shifts in FIB-4 over time and the development of HCC or a composite endpoint of cirrhosis and HCC in people with NAFLD. Patients with NAFLD treated at one of 130 VA hospitals between January 1, 2004, and December 31, 2008, were included in retrospective cohort research with follow-up through December 31, 2018.

They determined FIB-4 throughout treatment and classified patients into those at low, intermediate, or high risk for developing advanced fibrosis (FIB-4 1.45, 1.45-2.67, and >2.67). The effects of the FIB-4 change between the date of NAFLD diagnosis and the 3-year landmark period on the risk of HCC and a composite outcome were determined using landmark Fine-Gray competing risks models. A total of 473 individuals with NAFLD in the 3-year landmark analysis had HCC, for an incidence rate of 0.28 per 1,000 person-years (PY) (95% CI 0.26-0.30). 1.31 per 1,000 person-years (95% CI: 1.25-1.37) was the incidence rate for the composite outcome. 

Patients’ FIB-4 scores were low at 74.7%, indeterminate at 21.4%, and high at 3.8% at baseline. Patients with persistently high FIB-4 had the highest risk of HCC, and the composite endpoint (HCC adjusted sub-distribution hazard ratio 57.7, 95% CI 40.5-82.2 and composite endpoint hazard ratio 28.6, 95% CI 24.6-33.2), as compared to those with stable low FIB-4 at both periods. In addition, significant associations were found between alterations in FIB-4 over time and the development of cirrhosis and HCC.

Source: sciencedirect.com/science/article/abs/pii/S0168827822032998