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NAFLD fibrosis score, FIB-4 increase at similar rate in advanced fibrosis

Nonalcoholic fatty liver disease fibrosis scores and Fibrosis-4 index scores increased longitudinally and at a higher rate in those with fatty liver and fibrosis stage 2 or higher compared with those with stage 1 or no fibrosis, according to data.

“People with NAFLD have increased overall mortality when compared to a matched control population, and the most important predictor of mortality is the extent of liver fibrosis,” Preya J. Patel, BSc, MBBS, MRCP, from the Princess Alexandria Hospital in Brisbane, Australia, and colleagues wrote. “In this study we have shown that these low-cost simple scores increase progressively in patients with [clinically significant fibrosis (CFS)].”

The study comprised 230 patients with NAFLD. Among those included in the study, 31.3% had liver stiffness measurements of 8.2 kPa or higher (consistent with CFS), 23.91% had measurements of 9.5 kPA or higher (consistent with advanced fibrosis), and 16.9% had measurements higher than 13 kPa (consistent with concern for cirrhosis).

During a median of 5 years with a median of 11 retrospective observations, the rate of increased NAFLD fibrosis scores (NFS) was higher in patients with CFS than those without (0.17 vs. 0.06 units per year; P < .001). Similarly, the rate of increased log 10 FIB-4 scores was higher in those with CFS than those without (0.032 vs. 3e–4 units; P < .001).

The researchers observed higher rates of increased NFS and log 10 FIB-4 levels over time in patients with advanced fibrosis and those with cirrhosis compared with those without cirrhosis (P < .001 for all comparisons).

Subgroup analysis of patients with low fibrosis scores at baseline also revealed that the estimated rate of increased NFS (P = .03) and log 10 FIB-4 scores (P < .001) were higher in patients with CFS than in those without.

“Since fibrosis severity is a major factor predicting all-cause and liver-related mortality in NAFLD, assessment of fibrosis is fundamental in the management of these patients,” Patel and colleagues concluded. “Development of a predictive model using fibrosis status as the outcome is an important future step, in order to provide guidance for how this knowledge may be applied clinically, to identify patients at risk of developing advanced fibrosis over time.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.