Elevated liver fibrosis index FIB-4 is not reliable for HCC risk stratification in predominantly non-Asian CHB patients

Medicine (Baltimore). 2016 Sep;95(38):e4602. doi: 10.1097/MD.0000000000004602.

Abstract

We aimed to validate the liver fibrosis index FIB-4 as a model for risk stratification of hepatocellular carcinoma development in predominantly non-Asian patients with chronic hepatitis B infection seen at a tertiary referral center in Germany.We retrospectively analyzed 373 adult patients with chronic hepatitis B infection. Patient demographics, hepatitis B markers, antiviral treatment, laboratory parameters, results from liver imaging and histology were recorded. Patients were divided into 2 groups according to their FIB-4 levels and their hazard ratios for developing hepatocellular carcinoma were analyzed adjusted for age, sex, body mass index, alcohol consumption, and antiviral medication.Median follow-up was 8.7 years (range 1-21.3 years), 93% of patients were of non-Asian origin, and 64% were male. Compared with patients with a low FIB-4 (<1.25) patients with FIB-4 ≥1.25 showed a hazard ratio for incidence of hepatocellular carcinoma of 3.03 (95% confidence interval (CI): 1.24-7.41) and an adjusted hazard ratio of 1.75 (95% CI: 0.64-4.74). Notably, 68% of patients with liver cirrhosis and 68% of those who developed HCC during observation had a low FIB-4 (<1.25).We could not confirm that a FIB-4 value ≥1.25 is a reliable clinical indicator for incidence of hepatocellular carcinoma in predominantly non-Asian patients with chronic hepatitis B. Further studies in geographically and ethnically diverse populations are needed to prove its utility as a predictive tool.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Alanine Transaminase / blood
  • Antiviral Agents / therapeutic use
  • Aspartate Aminotransferases / blood
  • Biomarkers, Tumor / blood
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / etiology*
  • Carcinoma, Hepatocellular / virology
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Hepatitis B, Chronic / blood*
  • Hepatitis B, Chronic / complications
  • Humans
  • Incidence
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / virology
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / etiology*
  • Liver Neoplasms / virology
  • Male
  • Middle Aged
  • Platelet Count
  • Proportional Hazards Models
  • Reference Values
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index*

Substances

  • Antiviral Agents
  • Biomarkers, Tumor
  • Aspartate Aminotransferases
  • Alanine Transaminase