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FIB-4 most effective predictor of HCV complications
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The Fibrosis-4 score is more effective than the Child-Turcotte-Pugh and Model for End-Stage Liver Disease scores in predicting complications from hepatitis C virus, according to researchers.
“These results may help guide providers in prioritizing HCV–infected patients for treatment when resources to treat all HCV–infected persons are not available,” they wrote in Clinical Infectious Diseases.
Their study included the records of 21,116 chronic HCV–infected patients, gathered from the Electronically Retrieved Cohort of HCV–Infected Veterans (ERCHIVES) database. The ERCHIVES includes data from patients treated for the virus at any Department of Veterans Affairs facility starting in 2001.
The patients’ mean age was 53.1 years. Just over half (51.8%) were white, 36.7% were black and 97.7% were male.
The researchers compared Fibrosis-4 (FIB-4) with the Child-Turcotte-Pugh (CP) and Model for End-Stage Liver Disease (MELD) scores in measuring incident hepatic decomposition (HD), hepatocellular carcinoma (HCC) and all-cause mortality at 1, 3 and 5 years after baseline.
None of the patients died within the first year of follow-up. Assessments at 3 and 5 years showed patient deaths increased three- to seven-fold with higher FIB-4, MELD and CP scores.
Overall, however, the researchers found that none of the scores were effective in predicting deaths. The area under receiver operating characteristic (AUROC) for all-cause mortality in all three ranged from 0.65 to 0.68.
Associations were clearer for deaths related to definite or possible HCV–related liver disease. Among patients with a FIB-4 score higher than 3.25, mortality at 3 and 5 years was 15.1/1,000 and 30.2/1,000 patient-years of follow-up, respectively.
FIB-4 separated itself from the other scores in measuring HD and HCC. AUROC for HD at 1, 3 and 5 years ranged from 0.84 to 0.86 in FIB-4, and from 0.70 to 0.76 in MELD (P < .001).
Only 0.6% of patients with a FIB-4 score less than 1.45 had a first HD event at 3 years. That proportion increased to 15% of those with a FIB-4 score greater than 3.25.
HCC ranged from 0.81 to 0.82 in FIB-4, and from 0.61 to 0.68 in CP and MELD (P < .001).
Only 0.34% of patients with a FIB-4 score less than 1.45 had HCC at 5 years, compared with 8% of those with a score greater than 3.25.
The researchers stressed that their findings may provide a way to identify patients most in need of early therapy.
“With cost constraints and the fact that many HCV–infected persons may have little progression of disease for many years after infection, it is critical to identify those persons with HCV infection who are at highest risk of death or complications,” they wrote.
“Identification and prioritization of the highest risk patients can help spread the cost of treatment for the larger population over a period of time without jeopardizing the outcomes for those in greatest need of early treatment.” – by Joe Green
Disclosure: Butt’s institution has received grant support from Gilead Sciences, AbbVie and Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.
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