Fibrosis score 4 index has an independent relationship with coronary artery diseases in patients with metabolic-associated fatty liver disease

Abstract

Background Metabolic-associated fatty liver disease (MAFLD), one of the most common liver diseases, is detected in patients with concomitant hepatic steatosis and Type 2 Diabetes (T2D). We looked into the relationship between Fibrosis-4 (FIB-4) index and coronary artery diseases (CAD) in patients with MAFLD, to further look into the efficiency of FIB-4 in screening for CAD among patients with MAFLD. Method In this study, we included 1664 patients with MAFLD (T2D, who also had hepatic steatosis) during 2012–2022 and divided them into 2 groups; CAD and non-CAD. Demographic, Anthropometric indices, liver function tests, lipid profile and FIB-4 index of all patients were evaluated and compared. Result Among the 1644 patients (all have MAFLD), 364(21.4%) had CAD. Patients with MAFLD and CAD were more probable to be hypertensive, have longer duration of diabetes and be older (with p-values < 0.001). After adjustment for confounding factors, in a multivariable logistic regression model, FIB4 showed a significant independent relationship with concomitant MAFLD and CAD. Upper Tertile FIB-4 had an odds ratio of 3.28 (P-value = 0.002) to predict CAD. Furthermore, in Receiver Operating Characteristic (ROC) Curve analysis with the maximum Youden Index, a FIB-4 cut-off of 0.85 (AUC = 0.656, 95% CI 0.618–0.693, P < 0.001) noted to predict CAD in patients with MAFLD. Conclusion This study showed that the FIB-4 score independently correlates with CAD in patients with MAFLD.

Investigating the Association between Coronary Artery Disease and the Liver Fibrosis-4 Index in Patients Who Underwent Coronary Computed Tomography Angiography: A Cross-Sectional Study

“…FIB-4I serves as a predictive marker for CAD in patients with metabolically associated fatty liver disease, similar to patients with NAFLD [31]. The AUROC reported was 0.656, and the cut-off for FIB-4I was determined to be 0.85, which yielded a sensitivity of 75% and a specificity of 50%.…”

Non-alcoholic fatty liver disease biomarkers estimate cardiovascular risk based on coronary artery calcium score in type 2 diabetes: a cross-sectional study with two independent cohorts

“…Regarding non-invasive biomarkers of fibrosis, patients with an elevated NAFLD fibrosis score had a 346% increase in cardiovascular diseases in a prospective study including more than 4000 patients with NAFLD (8% had diabetes) [ 20 ]. In addition, the FIB-4 score was independently associated with the presence of coronary artery disease in patients with both NAFLD and T2D [ 41 ]. Lastly, the FibroTest® ≥ F2 stage was an independent predictor of cardiovascular events in 900 patients with T2D [ 34 ].…”

Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry

“…There may be a similar relationship between the heart and the liver, through a “cardio-hepatic syndrome” [ 2 , 3 ]. Recently, there have been several reports on the association between hepatic fibrosis and cardiovascular disease including coronary artery disease (CAD) [ 4 , 5 , 6 , 7 , 8 ], although the number of papers is small. A history of cardiovascular disease in 6087 patients without known liver disease who had participated in an annual health checkup examination was significantly more common in subjects with a high fibrosis-4 index (FIB-4I), which is an index of the severity of liver fibrosis [ 4 ].…”

“…A history of cardiovascular disease in 6087 patients without known liver disease who had participated in an annual health checkup examination was significantly more common in subjects with a high fibrosis-4 index (FIB-4I), which is an index of the severity of liver fibrosis [ 4 ]. FIB4-I is closely associated with CAD in type 2 diabetes mellitus (DM) [ 5 ] and in metabolic-associated fatty liver disease [ 6 ]. FIB-4I is a valuable biomarker for predicting not only liver-related events but also extrahepatic cancers and major adverse cardiovascular events (MACEs) [ 7 ].…”