FIB-4 as a Time-varying Covariate and Its Association With Severe Liver Disease in Primary Care: A Time-dependent Cox Regression Analysis.

Autor:	Schreiner AD; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Zhang J; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Moran WP; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Koch DG; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Marsden J; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Livingston S; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Bays C; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Mauldin PD; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC., Gebregziabher M; Department of Medicine, Medical University of South Carolina, Charleston, SC.; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
Jazyk:	angličtina
Zdroj:	Journal of clinical gastroenterology [J Clin Gastroenterol] 2024 Oct 01; Vol. 58 (9), pp. 917-922. Date of Electronic Publication: 2024 Oct 01.
DOI:	10.1097/MCG.0000000000001935
Abstrakt:	Background and Goals: The Fibrosis-4 Index (FIB-4) has demonstrated a strong association with severe liver disease (SLD) outcomes in primary care, but previous studies have only evaluated this relationship using 1 or 2 FIB-4 scores. In this study, we determined the association of FIB-4 as a time-varying covariate with SLD risk using time-dependent Cox regression models. Study: This retrospective cohort study included primary care patients with at least 2 FIB-4 scores between 2012 and 2021. The outcome was the occurrence of an SLD event, a composite of cirrhosis, complications of cirrhosis, hepatocellular carcinoma, and liver transplantation. The primary predictor was FIB-4 advanced fibrosis risk, categorized as low-(<1.3), indeterminate-(1.3≤FIB to 4<2.67), and high-risk (≥2.67). FIB-4 scores were calculated and the index, last, and maximum FIB-4s were identified. Time-dependent Cox regression models were used to estimate hazard ratios (HR) and their corresponding 95% CI with adjustment for potentially confounding covariates. Results: In the cohort, 20,828 patients had a median of 5 (IQR: 3 to 11) FIB-4 scores each and 3% (n=667) suffered an SLD outcome during follow-up. Maximum FIB-4 scores were indeterminate-risk for 34% (7149) and high-risk for 24% (4971) of the sample, and 32% (6692) of patients had an increase in fibrosis risk category compared with their index value. The adjusted Cox regression model demonstrated an association between indeterminate- (hazard ratio 3.21; 95% CI 2.33-4.42) and high-risk (hazard ratio 20.36; 95% CI 15.03-27.57) FIB-4 scores with SLD outcomes. Conclusions: Multiple FIB-4 values per patient are accessible in primary care, FIB-4 fibrosis risk assessments change over time, and high-risk FIB-4 scores (≥2.67) are strongly associated with severe liver disease outcomes when accounting for FIB-4 as a time-varying variable. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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