Repeat FIB-4 Blood Tests Help Predict Cirrhosis

Ingrid Hein

August 25, 2020

Repeat fibrosis-4 (FIB-4) scores can be used to identify people at greatest risk for cirrhosis of the liver, new research shows.

Hannes Hagström

"Done repeatedly, this test can improve prediction capacity to identify who will develop cirrhosis of the liver later in life," said lead researcher Hannes Hagström, MD, from the Karolinska University Hospital in Stockholm.

A FIB-4 score that rises from one test to the next indicates that a person is at increased risk for severe liver disease, whereas a score that drops indicates a decreased risk, he told Medscape Medical News. The study results — published online July 1 in the Journal of Hepatology — will be presented at the Digital International Liver Congress 2020 this week.

The noninvasive, widely available, cheap FIB-4 test — which is calculated on the basis of age, transaminase level, and platelet count — is commonly used to identify the risk for advanced fibrosis in liver disease, but it has not been used to predict future risk.

To evaluate risk for cirrhosis, Hagström and his colleagues looked at 812,073 blood tests performed from 1985 to 1996 on people enrolled in the Swedish Apolipoprotein Mortality Risk (AMORIS) study.

They excluded people younger than 35 years and older than 79 years and anyone with a diagnosis of any liver disease at baseline.

The 40,729 people who had two FIB-4 measurements taken less than 5 years apart were included in the analysis. Test results were categorized into three risk groups: low (<1.30), intermediate (1.30 - 2.67), and high (>2.67).

After a median of 16.2 years, 11,929 people in the study cohort had died and 581 had a severe liver disease event.

Severe liver disease events were more common in people who had both tests categorized as high risk than in people who had both tests categorized as low risk (13.2% vs 1.0%; aHR, 17.04; 95% CI, 11.67 - 24.88).

The researchers found that a one-unit increase between the two test results was continuously predictive of a severe liver disease event (aHR, 1.81; 95% CI, 1.67 - 1.96).

One Test Not Enough

The absolute risk for severe liver disease in the general population is 2%, but the FIB-4 score is elevated in about one-third of people in the general population.

"A lot of people who have increased levels of this biomarker will never develop cirrhosis," Hagström told Medscape Medical News.

Although two FIB-4 scores might not identify everyone who will get cirrhosis, comparing scores provides insight into who is at greatest risk, he explained.

This information can be useful, particularly for primary care doctors. If you know that someone is at higher risk, "you can send that patient for a FibroScan, which is a much more sensitive measurement," but also much more expensive. "Now we can better know who to send," he said.

However, "the main problem is that these tests are not widely known" or used enough by primary care doctors, Hagström said.

A lack of knowledge about the utility of this test is a problem, agreed Jérôme Boursier, MD, PhD, from Angers University in France.

"The younger doctors are using these tests more often," he told Medscape Medical News, but "the older doctors are not aware they exist."

This study supports repeating the tests. "One test offers quite poor prediction," Boursier said. But "when you have a higher score on a second one, this can help the conversation with the patient."

Hagström and Boursier have disclosed no relevant financial relationships.

J Hepatol. Published online July 1, 2020. Full text

Digital International Liver Congress (ILC) 2020: Abstract AS096. To be presented August 27, 2020.

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