Abstract
Liver disease is frequently asymptomatic, challenging early identification in the primary care setting. The fibrosis 4 (FIB4) index is a liver fibrosis biomarker that is a potential alternative to liver biopsy for diagnosing and managing liver disease. This study aimed to calculate the FIB4 index for screening individuals at high risk of liver disease at the community level. This was a retrospective real-world study analyzing blood and serum test results from a central laboratory. The primary outcome was the number of individuals within each risk category for hepatic fibrosis: high risk (FIB4 ≥ 3.25) and low risk (FIB4 < 1.3). The analysis included samples from 31,753 patients, of which 18,102 were aged 40 to 75 years. In these patients, the FIB4 index had been explicitly requested in 1852 (10.2%) cases and estimated ad hoc in the rest. Of the 263 (1.5%) cases with FIB4 ≥ 3.25, the FIB4 index was requested in 46 (17.5%), and 52 (19.8%) showed evidence of liver fibrosis in their medical records, while the rest did not report any data regarding liver fibrosis. FIB4 is a simple score that can play a role as a “red flag” for early identification of patients at high risk of advanced liver fibrosis and their referral to specialized care.
Highlights
Chronic liver disease is a major cause of mortality globally and leads to a substantial healthcare burden
Patients Included and Their Distribution According to the fibrosis 4 (FIB4) Index
The FIB4 estimate was requested by the physician in 1852 (10.2%) cases, while in the remaining 16,250, the index was calculated ad hoc for the purpose of the study
Summary
Chronic liver disease is a major cause of mortality globally and leads to a substantial healthcare burden. The causes of liver disease may vary depending on the region and patient’s age, but viral hepatitis infections, metabolic-associated fatty liver disease (MAFLD), and alcohol consumption are the most common etiologic agents. Regardless of the cause, chronic liver disease often presents asymptomatically until advanced phases, when liver damage is irreversible and therapy can only slow or stop progression of the disease [1,2]. Diagnosis of liver disease, in the primary care setting, is a mainstay to change this undesirable scenario. Liver disease is suspected from the elevation of hepatic enzymes and further confirmed by liver biopsy. Patients with advanced liver disease do not show liver enzyme alterations precluding suspicions for deciding its diagnosis
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