Validation of the fibrosis-4 (FIB-4) index in the diagnosis of liver disease of rheumatoid arthritis patients treated with methotrexate

Miyata, Masayuki; Kuroda, Masashi; Unakami, Masamitsu; Tasaki, Kazuhiro; Migita, Kiyoshi; Ohira, Hiromasa

doi:10.1080/14397595.2018.1542962

Cited by 17 publications

(22 citation statements)

References 25 publications

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“…21,22 Other non-invasive liver fibrosis screening tests include Hepascore, aminoaspartate transaminase (AST) to platelet ratio index (APRI), Fibrosis-4 index (FIB-4) and transient elastography (TE), which have been validated in patients with a variety of liver diseases but not MTX-induced liver fibrosis, complicating treatment of RA. 16,20,[23][24][25][26][27][28] The APRI is calculated by: (AST in IU/L)/(AST upper limit of normal in IU/L)/(platelets in 10 9 /L), which generates a value used to estimate the risk of significant fibrosis. One study has assessed the utility of the APRI in RA and suggested that APRI scores correlated with liver fibrosis in RA patients.…”

Section: Introductionmentioning

confidence: 99%

“…Age has been shown to affect the accuracy of the FIB-4 test, and subsequently age-group appropriate cut-off values have been recommended. 25,33 A single study examining FIB-4 in RA patients taking MTX found it to be useful in detecting liver fibrosis when compared with liver biopsy. 25 Transient elastography (TE) uses a non-invasive transducer that emits low amplitude, low frequency vibrations that essentially propagate an elastic shear wave through the liver.…”

Section: Introductionmentioning

confidence: 99%

“…25,33 A single study examining FIB-4 in RA patients taking MTX found it to be useful in detecting liver fibrosis when compared with liver biopsy. 25 Transient elastography (TE) uses a non-invasive transducer that emits low amplitude, low frequency vibrations that essentially propagate an elastic shear wave through the liver. 14,28 The velocity of these are measured and generate a continuous score in kilopascals (kPa), which has been extensively studied in a range of liver diseases 2 where it correlates with the ordinal Metavir staging score from F0 (absent fibrosis) to F4 (cirrhosis).…”

Section: Introductionmentioning

confidence: 99%

“…Conventional B‐mode ultrasound is a well established imaging modality for detecting morphological parenchymal liver changes and overt cirrhosis, 21 but is highly operator dependant and has limited ability to assess the presence or severity of fibrosis 21,22 . Other non‐invasive liver fibrosis screening tests include Hepascore, aminoaspartate transaminase (AST) to platelet ratio index (APRI), Fibrosis‐4 index (FIB‐4) and transient elastography (TE), which have been validated in patients with a variety of liver diseases but not MTX‐induced liver fibrosis, complicating treatment of RA 16,20,23–28 …”

Section: Introductionmentioning

confidence: 99%

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Assessment of liver fibrosis markers in people with rheumatoid arthritis on methotrexate

Olsson-White

Olynyk

Ayonrinde

et al. 2022

Internal Medicine Journal

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Background: Up to 3% of methotrexate (MTX)-treated rheumatoid arthritis (RA) patients might develop liver fibrosis or cirrhosis, requiring effective screening algorithms.Aims: To assess the utility of non-invasive liver fibrosis assessment in RA patients on MTX.Methods: Fifty-six patients were recruited from rheumatology outpatient clinics in a public tertiary centre from July 2017 to October 2018. Clinical data was collected. Screening for hepatic fibrosis was performed using transient elastography (TE), aminoaspartate transaminase to platelet ratio index (APRI), Hepascore and Fibrosis-4 index (FIB-4). Those with suspected significant liver fibrosis based on these screening tests were assessed by a hepatologist.Results: Twenty-seven patients were suspected to have liver fibrosis on screening, including 10/56 (18%) by TE, 20/56 (36%) by Hepascore, 2/56 by APRI (4%) and 1/56 by FIB-4 (2%). Of these 27 patients, 11 were reviewed by a hepatologist and one diagnosed with significant liver fibrosis. TE, but not APRI, Hepascore or FIB-4, was found to have 100% sensitivity and 84% specificity (P = 0.029) for hepatologist-diagnosed liver fibrosis. Conclusion:Liver fibrosis develops in a minority of MTX-treated RA patients. The present study suggests that TE is a more sensitive screening test than APRI, FIB-4 or Hepascore in the identification of people with RA at risk of hepatic fibrosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of liver fibrosis markers in people with rheumatoid arthritis on methotrexate

Olsson-White

Olynyk

Ayonrinde

et al. 2022

Internal Medicine Journal

View full text Add to dashboard Cite

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“…[10][11][12] Besides evaluating chronic liver diseases, FIB-4 has been used to assess liver fibrosis and its relation with other systemic inflammatory diseases or conditions, including arterial stiffness/abnormal central hemodynamics in heart failure, cerebral white matter hyperintensity, rheumatoid arthritis, and polyangiitis. [13][14][15][16][17] Accordingly, we investigated whether liver fibrosis assessed using FIB-4 is associated with all-cause mortality in patients with COPD, based on the concept that liver fibrosis might be a sequela of hepatic or systemic inflammation.…”

Section: Introductionmentioning

confidence: 99%

<p>Hepatic Fibrosis Assessed Using Fibrosis-4 Index Is Predictive of All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease</p>

Yong

Leem

Kim

et al. 2020

COPD

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Background: Various comorbidities influence the prognosis of patients with chronic obstructive pulmonary disease (COPD). We investigated if liver fibrosis assessed using fibrosis-4 index (FIB-4) is associated with all-cause mortality in patients with COPD. Methods: We included 756 patients diagnosed with COPD between 2006 and 2010. Medical records were retrospectively reviewed until 2018. FIB-4 was calculated using the following equation: [age (years) × aspartate aminotransferase (IU/L)/(platelet count (10 9 /L) × √alanine aminotransferase (IU/L))]. Results: From a total of 756 patients, 582 (76.9%) patients were categorized into survivor and 174 (23.1%) into non-survivor groups. The non-survivor group was significantly older with a higher proportion of male, smoker and lower FEV 1 /FVC ratio than the survivor group (all P<0.05). Various comorbidities were more frequently observed in the non-survivor group (P<0.05). In addition, the non-survivor group had significantly higher FIB-4 than the survivor group (1.8 vs 1.4, P<0.001). In multivariate analysis, older age (hazard ratio [HR] =1.05), underlying malignancy (HR=2.94), coronary artery occlusive disease (HR=1.58), higher FIB-4 (HR=1.15), and higher GOLD stage (HR=1.26) were significantly associated with the increased risk of all-cause mortality (P<0.05), whereas body mass index (HR=0.95) was independently protective for all-cause mortality (all P<0.05). The high FIB-4 (>1.57) group showed a significantly lower cumulative survival rate than the low FIB-4 (≤1.05) group (P=0.031, Log-rank test). In multivariate regression analysis, higher FIB-4 independently predicted the risk of acute exacerbation (odds ratio=1.08, P=0.034). Conclusion: Higher fibrotic burden assessed using FIB-4 was independently predictive of the increased risk of all-cause mortality and acute exacerbation in patients with COPD.

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Liver Involvement in Rheumatic Diseases

Takahashi

Ohira

2019

Gastrointestinal and Hepatic Manifestations of Rheumatic Diseases

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Validation of the fibrosis-4 (FIB-4) index in the diagnosis of liver disease of rheumatoid arthritis patients treated with methotrexate

Cited by 17 publications

References 25 publications

Assessment of liver fibrosis markers in people with rheumatoid arthritis on methotrexate

Assessment of liver fibrosis markers in people with rheumatoid arthritis on methotrexate

<p>Hepatic Fibrosis Assessed Using Fibrosis-4 Index Is Predictive of All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease</p>

Liver Involvement in Rheumatic Diseases

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