The Appropriate Opportunity for Evaluating Liver Fibrosis by Using the FIB-4 Index in Patients with Nonalcoholic Fatty Liver Disease in Japan.

Yuya Seko,Michihisa Moriguchi,Seita Kataoka,Kota Yano,Yoshito Itoh,Shinya Okishio,Atsushi Umemura,Keiichiroh Okuda,Aya Takahashi,Kanji Yamaguchi,Saiyu Tanaka

doi:10.3390/diagnostics10100842

Yuya Seko, Michihisa Moriguchi + Show 9 more

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https://doi.org/10.3390/diagnostics10100842

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Abstract

In patients with nonalcoholic fatty liver disease (NAFLD), liver fibrosis is the predictive factor for liver-related events and prognosis. This retrospective study aimed to evaluate longitudinal changes in the FIB-4 index and to determine a strategy for diagnosing and following patients with NAFLD using this index. We analyzed the FIB-4 index at baseline and after 1 and 5 years in 272 consecutive patients with biopsy-proven NAFLD. Of these, 52 patients underwent serial biopsies. The change in the FIB-4 index was correlated with changes in the fibrosis stage among these patients (p = 0.048). The median FIB-4 index was 1.64 at baseline, 1.45 at 1 year, and 1.74 at 5 years. The negative predictive value for advanced fibrosis at a low cutoff point was 90.4/90.1 at baseline/1 year. Its specificity at a high cutoff point increased from 65.0% at baseline to 82.3% at 1 year. Multivariate analysis identified the FIB-4 index at 1 year as a predictive factor for a FIB-4 index > 2.67 at 5 years. A FIB-4 index < 1.30 was acceptable for excluding advanced fibrosis at baseline. In contrast, to evaluate and predict advanced liver fibrosis with the FIB-4 index at a high cutoff point, we should use the index at 1 year after appropriate therapy.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Japan, and it affects up to 25–30% of the general adult population worldwide [1]
NAFLD is one of the phenotypes of metabolic syndrome in the liver, and it encompasses a wide spectrum of liver pathology, ranging from non-alcoholic fatty liver (NAFL), which is usually benign, to non-alcoholic steatohepatitis (NASH), which is characterized by steatosis, lobular inflammation, and hepatocellular injury, and may progress to liver cirrhosis (LC), hepatic failure, and hepatocellular carcinoma (HCC) in the absence of significant alcohol consumption
Staging of liver fibrosis in patients with NAFLD is essential for stratifying patients according to prognosis, treatment strategy, and guiding surveillance for the development of HCC

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Japan, and it affects up to 25–30% of the general adult population worldwide [1]. A recent large cohort study reported that hepatic fibrosis was the only predictive factor of liver-related events and the mortality of patients with NAFLD [2,3]. These results indicate that accurate staging of fibrosis is clinically important for patients with NASH to prevent severe complications. Patients with NAFLD, those with advanced symptoms, are at high risk for HCC and death from liver-related causes.

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