title: High liver fibrosis index FIB-4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers.
abstract: Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7≤ FIB-4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50-13.92) and subjects with FIB-4 ≥2.4 showed an aHR of 21.34 (95% CI: 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index: 0.701 vs. 0.831; P = 0.001). FIB-4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C-index: 0.775 vs. 0.701; P = 0.040).
  
  
  CONCLUSIONS
  High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB-4 may play a valuable role in HCC screening among HBsAg carriers.
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Beomseok
authors.initials: B
authors.lastname: Suh
authors.forename: Sehhoon
authors.initials: S
authors.lastname: Park
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Yun
authors.forename: Hyung-Kook
authors.initials: HK
authors.lastname: Yang
authors.forename: Su Jong
authors.initials: SJ
authors.lastname: Yu
authors.forename: Cheong-Il
authors.initials: CI
authors.lastname: Shin
authors.forename: Jin-Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Eunmi
authors.initials: E
authors.lastname: Ahn
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Park
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase