Less liver fibrosis marker increment in overweight chronic hepatitis B patients observed by age-adjusted Fibrosis-4 Index

Abstract

Background and aimsChronic hepatitis B patients in Taiwan with no or limited liver injury are not reimbursed for antiviral treatment by the Taiwan National Health Insurance (NHI). Innovative fibrosis marker, age-adjusted Fibrosis-4 Index (FIB4-AA), was implemented to evaluate the tendency of liver fibrosis in these patients.MethodsThe FIB-4 indices of 256 antiviral treatment-naïve chronic hepatitis B patients at Kaohsiung Medical University Hospital from 2003 to 2019 were reviewed. The difference in initial FIB-4 and last FIB4-AA was treated as a categorical variable, representing the tendency of liver fibrosis in each individual aside from ageing. Logistic regression was implemented to evaluate the three parameters most dependent on increment of FIB4-AA: e seroconversion, body mass index (BMI) and initial FIB-4 index.ResultsThe yearly FIB-4 growth rate of an individual without chronic hepatitis was lower than that of the study group (0.0237 vs 0.0273 for males, 0.02 vs 0.0288 for females). Patients undergoing or completing e seroconversion were less prone to increment of FIB4-AA (p=0.036, OR 0.524). Logistic regression revealed that BMI ≥25 kg/m2 significantly less increment of FIB4-AA (p=0.001, OR 0.383, 95% CI 0.212 to 0.690), while patients with initial FIB-4 <1.29 were prone to increasing liver FIB4-AA (p=0.000, OR 3.687, 95% CI 1.999 to 6.797).ConclusionChronic hepatitis B patients not meeting the reimbursement criteria of the Taiwan NHI are prone to increment of liver fibrosis marker. Overweight is associated with less increment of fibrosis marker, while initial FIB-4 <1.29 is associated with increasing fibrosis marker.

The compound annual growth rate of the fibrosis‐4 index in chronic hepatitis B patients

“…As described in our previous literature, 9 the formula for FIB-4 included age as a multiplier, which clearly indicated that FIB-4 increases naturally during aging. To neutralize the influence of aging during the follow-up period, we calculated the patient's last FIB-4…”

“…The dramatically lowered significance of FIB4-AA (p = 0.004), contrasting with that of the components of FIB-4 ALT (p = 1.000), PLT (p = 0.073), and AST (p = 0.205), demonstrated that FIB4-AA, comprised AST, ALT, and PLT, without taking into account the influence of age, truly reflects the association between liver fibrosis progression and overweight BMI. 9 A negative CAGR (À2.36% ± 3.52%) was obtained from the group with negative FIB4-AA growth in this study. Negative FIB4-AA growth was shown to be associated with seroconversion and overweight BMI in our previous publication, 9 and a 10 times smaller (0.38% ± 10.35% vs. 3.83% ± 8.88%, p = 0.009) in this study (Table 4).…”

“…The study cohort has been described in a previous publication. 9 CHB patients with relatively low disease activity or, by definition, those who had been regularly followed at three-month interval and did not match the reimbursement criteria of the current Taiwan NHI (Table S1) for antiviral treatment. In the same cohort, patients with positive FIB4-AA growth, designated FIB4-AA(+) or FIB4-AA positive in this study, were considered to have a tendency of liver fibrosis, while patients with negative FIB4-AA growth were considered to have less fibrotic risk and were designated FIB4-AA(À) or FIB4-AA negative.…”

“…Resuming our previous study, 9 totally 244 antiviral treatmentnaïve CHB patients regularly followed at Kaohsiung Medical University Hospital who provided records of at least two sets of FIB-4 data were enrolled. Figure S1 The BMI is the weight in kilograms divided by the square of the height in meters.…”

“…7 Based on pathological findings, some studies have even suggested an annual growth rate of fibrosis. 8 In our previous study, 9 an increasing age-adjusted FIB-4 (FIB-4-AA) was shown to imply a tendency of liver fibrosis among CHB patients, and the fibrosis process of these patients needs to be further elucidated.…”