Assessing Liver Fibrosis Using the FIB4 Index in the Community Setting

Blanco‐Grau, Albert; Gabriel-Medina, Pablo; Rodríguez-Algarra, Francisco; Villena-Ortiz, Yolanda; López-Martínez, Rosa; Augustín, Salvador; Pons, Mónica; Cruz, Luz-Maria; Rando-Segura, Ariadna; Enfedaque, Belén; Riveiro, Mar; Casis, Ernesto; Ferrer-Costa, Roser; Buti, Marı́a; Rodríguez‐Frías, Francisco

doi:10.3390/diagnostics11122236

Cited by 30 publications

(20 citation statements)

References 38 publications

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“… 12 As a potential alternative, the FIB-4 index is a liver fibrosis marker for the assessment of liver disease, acting as a ‘red flag’. 13 A FIB-4 cut-off of ≥3.25 is currently validated for metabolic-associated fatty liver disease. 13 Our patient had a FIB-4 index of 6.4, reflecting a high risk of advanced liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Silymarin and management of liver function in nonalcoholic steatohepatitis: a case report

Hashem¹

2023

DIC

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Non-alcoholic fatty liver disease (NAFLD) and its progressive form (non-alcoholic steatohepatitis; NASH) are the main reason for chronic liver disease in the general population, characterized by fat accumulation in hepatocytes (steatosis) and anomalies in liver biochemical analyses. To date, no pharmacological agents have been approved for NAFLD or NASH treatment. However, silymarin, the active ingredient in milk thistle, has been used in the last decades for the treatment of several liver diseases. In this case report, treatment with silymarin 140 mg three-times daily highlighted moderate efficacy and a good safety profile in the management of NASH and liver function, as it decreased serum AST and ALT levels over the treatment period with no side-effects, supporting silymarin as a promising supplemental intervention that can normalize liver activity in NAFLD and NASH. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series . Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series

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Section: Discussionmentioning

confidence: 99%

Silymarin and management of liver function in nonalcoholic steatohepatitis: a case report

Hashem¹

2023

DIC

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“…19 The Fibrosis 4 (FIB4) index is a simple score that may be useful in the community management of those with diabetes to identify those at risk of advanced liver fibrosis who require referral to specialist care. 20 The NAFLD fibrosis score is a prognostic predictor of mortality and liver complications among those with MAFLD 21 that could also be integrated into the screening strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Routine liver tests have poor diagnostic accuracy, 18 while tools that improve detection of early‐stage cirrhosis, such as elastography and the enhanced liver fibrosis test (ELF), are not widely available outside of specialist settings 19 . The Fibrosis 4 (FIB4) index is a simple score that may be useful in the community management of those with diabetes to identify those at risk of advanced liver fibrosis who require referral to specialist care 20 . The NAFLD fibrosis score is a prognostic predictor of mortality and liver complications among those with MAFLD 21 that could also be integrated into the screening strategy.…”

Section: Discussionmentioning

confidence: 99%

Liver disease mortality and hospitalisations among people with type 2 diabetes mellitus: A population‐based study

Tomic,

Salim,

George

et al. 2023

Liver International

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Background and AimsThe burden of liver disease among people with diabetes at a population level is unknown. We explored the burden and trends of liver disease mortality and hospitalisations among Australians with diabetes.MethodsWe linked Australians with type 2 diabetes on the National Diabetes Services Scheme to the National Death Index for 2002–2019 to determine trends in the proportion of deaths due to liver disease, overall and by subcategory. We also determined the leading reasons and risk factors for liver disease hospitalisations in those with diabetes over this period. Finally, we compared the burden of liver disease hospitalisations among those with diabetes to the general population using excess hospitalisations per 100 000 person‐years.ResultsAmong Australians with type 2 diabetes (n = 1 122 431) liver diseases accounted for between 1.5% and 1.9% of deaths between 2002 and 2019, roughly one‐third of the proportion of deaths caused by kidney disease. The proportion of deaths due to inflammatory liver diseases among those with diabetes increased from .08% in 2002 to .27% in 2019. Alcohol‐related liver disease accounted for the greatest share (22.7%) of liver disease hospitalisation in those with diabetes, but the number of hospitalisations for this condition declined over time. Compared to the general population, men (RR 3.63, 95% CI 3.44–3.84) and women (RR 4.49, 4.21–4.78) with diabetes were at higher risk of hospitalisation for fibrosis and cirrhosis; however, this did not translate to a substantial excess risk per 100 000 population.ConclusionsBetter screening methods for liver disease among people with diabetes should be developed and implemented into practice.

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“…Hypertension was defined as a systolic or diastolic blood pressure ≥ 130/85 or the use of antihypertensive [26] . Major adverse cardiovascular events (MACE) was an umbrella definition encompassing heart failure events, stroke, myocardial infarction and mortality [27] . Advanced fibrosis was assessed by fibrosis-4 index (FIB-4), where a cut-off value of FIB < 1.3 [28] was defined as having a low risk of advanced fibrosis [29] .…”

Section: Methodsmentioning

confidence: 99%

The growing prevalence of nonalcoholic fatty liver disease (NAFLD), determined by fatty liver index, amongst young adults in the United States. A 20-year experience

Li¹,

Ng²,

Quek³

et al. 2022

Metab Target Organ Damage

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Aim: The Global burden of nonalcoholic fatty liver disease (NAFLD) has significantly increased recently, with its prevalence mirroring increasing obesity and diabetes. However, population-specific evidence for young adults remains limited. Herein, we provide a 20-year trend analysis of NAFLD in young adults and examine factors associated with NAFLD and major adverse cardiovascular events (MACE) prevalence. Methods: This study uses data from the United States National Health and Nutrition Examination Survey (NHANES) 1999-2018. Fatty liver was examined with the fatty liver index (FLI) and United States-FLI (US-FLI), and advanced fibrosis was examined with the fibrosis-4 index. Clustered multivariate logistic regression analysis on the year of study was applied to obtain odds ratios (OR) for the estimation of events. Results: 13.31% (95%CI: 12.71% to 13.94%) of young adults had NAFLD. The prevalence increased from 9.98% in 1999 to 19.49% in 2018, with a statistically significant trend (P < 0.001). 9.52% and 5.29% of patients have clinically significant and advanced fibrosis, respectively. In multivariate analysis, diabetes (3.48, 95%CI: 2.37 to 5.11), hypertension (2.03, 95%CI: 1.62 to 2.55), elevated body mass index (1.22, 95%CI: 1.20 to 1.23, P < 0.001) significantly increases odds of NAFLD. The largest increase in odds was related to obesity (OR: 21.61, 95%CI: 16.95 to 27.55, P < 0.001). Young adults with NAFLD had a borderline non-significant increase in the prevalence of MACE compared to individuals without NAFLD (OR: 1.603, 95%CI: 0.949 to 2.708, P = 0.078). Conclusion: The rising prevalence of NAFLD in young adults depicts the changing landscape of NAFLD and its association with a significant increase in MACE. The challenge of effective risk stratification and education of these individuals remains.

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Assessing Liver Fibrosis Using the FIB4 Index in the Community Setting

Cited by 30 publications

References 38 publications

Silymarin and management of liver function in nonalcoholic steatohepatitis: a case report

Silymarin and management of liver function in nonalcoholic steatohepatitis: a case report

Liver disease mortality and hospitalisations among people with type 2 diabetes mellitus: A population‐based study

The growing prevalence of nonalcoholic fatty liver disease (NAFLD), determined by fatty liver index, amongst young adults in the United States. A 20-year experience

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