title: High FIB-4 index as an independent risk factor of prevalent chronic kidney disease in patients with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Growing evidence suggests that non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk for chronic kidney disease (CKD); liver fibrosis with biopsy-proven NAFLD has also been shown to associate with an increased risk of CKD. This study compares the diagnostic performance of simple noninvasive tests in identifying prevalent CKD among individuals with ultrasonography-diagnosed NAFLD.
  
  
  METHODS
  A total of 755 with ultrasonography-diagnosed NAFLD were included. Estimated glomerular filtration rate and noninvasive markers for hepatic fibrosis: aspartate transaminase to alanine transaminase ratio (AAR), aspartate transaminase to platelet ratio index (APRI), FIB-4 score, NAFLD fibrosis score (NFS) and BARD score were assessed.
  
  
  RESULTS
  Binary logistic regression to generate a propensity score and receiver operating characteristic curves were developed for each of the noninvasive markers for predicting CKD, and the area under the receiver operating characteristic curve was greatest for FIB-4 score (0.750), followed by NFS (0.710), AAR (0.594), APRI (0.587), and BARD score (0.561). A cut-off value of 1.100 for FIB-4 score gave a sensitivity of 68.85% and a specificity of 71.07% for predicting CKD. The positive predictive value and negative predictive value were 37.50 and 90.05%, respectively. In multiple logistic regression analysis, only FIB-4 score ≧1.100 (OR 2.660, 95% CI 1.201-5.889; p = .016), older age, higher diastolic blood pressure and higher uric acid were independent predictors of CKD.
  
  
  CONCLUSIONS
  High noninvasive fibrosis score is associated with an increased risk of prevalent CKD; the FIB-4 is the better predictor. With a cut-off value of 1.100 for FIB-4, it is useful in excluding the presence of CKD in patients with NAFLD.
authors.affiliation: Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Chiayi, Taiwan. dr.xuhw@gmail.com.
authors.forename: Huang-Wei
authors.initials: HW
authors.lastname: Xu
authors.affiliation: Department of Nephrology and Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan. libra@cgmh.org.tw.
authors.forename: Yung-Chien
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: School of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan. chchang@gw.cgust.edu.tw.
authors.forename: Chia-Hao
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Chiayi, Taiwan. wkliang@cgmh.org.tw.
authors.forename: Kuo-Liang
authors.initials: KL
authors.lastname: Wei
authors.affiliation: Department of Nephrology and Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan. linchunliang@adm.cgmh.org.tw.|School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. linchunliang@adm.cgmh.org.tw.
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers
keywords: Chronic kidney disease; FIB-4; Liver fibrosis; Non-alcoholic fatty liver disease