Abstract
Age is a major contributor to the liver fibrosis rate and its adverse health-related outcomes, including mortality, but older populations are still under-explored. We investigated multimorbidity and inflammatory biomarkers in relation to the increasing liver fibrosis risk to delineate 8-year all-cause mortality trajectories in 1929 older adults from the population-based Salus in Apulia Study. Liver fibrosis risk was assumed using the fibrosis-4 (FIB-4) score, assigned to three liver fibrosis risk groups (low, intermediate, high). In the secondary analyses, the APRI score was also calculated to allow for comparisons. Male subjects (prevalence difference: −13.49, 95% confidence interval (CI): −18.96 to −8.03), a higher multimorbidity burden (effect size, ES: −0.14, 95% CI: −0.26 to −0.02), a higher prevalence of physical frailty (ES: 6.77, 95% CI: 0.07 to 13.47), and a more pronounced inflammatory pattern as indicated by tumor growth factor-α circulating levels (ES: −0.12, 95% CI: −0.23 to −0.01) were significantly more common in the highest-risk FIB-4 score group. Liver function characterized by lipid profile and platelet levels worsened with increasing FIB-4 risk score. The 8-year risk of death was nearly double in subjects in the highest-risk FIB-4 score group, even after controlling for possible confounders. Furthermore, a steeper mortality curve was clearly observed for FIB-4 scores as compared with the APRI scoring system with respect to liver fibrosis risk. In conclusion, using a scoring tool based on simple routine biomarkers to detect liver fibrosis risk may enhance biological knowledge of age-related outcomes of chronic liver disease and be helpful in the clinical setting to identify subjects at risk for adverse health-related outcomes, including mortality.
Highlights
We assessed the large dataset of the population-based Salus in Apulia Study to evaluate multimorbidity and inflammatory biomarkers, as well as other routine biomarkers, in relation to three risk categories of the noninvasive liver fibrosis score (FIB-4) and 8-year all-cause mortality among older adults in Southern Italy
The present study offered evidence that older adults with a high risk of liver fibrosis according to the noninvasive FIB-4 scoring system have poorer 8-year survival, and yet this scoring system performs better in comparison with the AST/platelet ratio index (APRI) in terms of predicting overall mortality
The present finding is expected to be of interest within clinical screening contexts and comprehensive geriatric assessment (CGA), suggesting new applicative scenarios of the FIB-4 well beyond single-use for prognostic liver fibrosis purposes, covering a broader spectrum in predicting liver health trajectories and major health-related outcomes
Summary
The natural history of CLD encompasses progression to cirrhosis and HCC, not all affected subjects undergo this progression It seems that liver fibrosis is the main determinant of disease progression; people with a higher degree of liver fibrosis are more prone to poorer long-term outcomes [7,8]. Data on older people are very limited In this context, very recent findings from the InCHIANTI prospective study provided evidence that the fibrosis risk in late-life was closely associated with a raised hazard for general and cardiovascular mortality and physical disability, regardless of multimorbidity and other potential confounders [14]. We assessed the large dataset of the population-based Salus in Apulia Study to evaluate multimorbidity and inflammatory biomarkers, as well as other routine biomarkers, in relation to three risk categories of the noninvasive liver fibrosis score (FIB-4) and 8-year all-cause mortality among older adults in Southern Italy
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