title: Elevated liver fibrosis index FIB-4 is not reliable for HCC risk stratification in predominantly non-Asian CHB patients.
abstract: We aimed to validate the liver fibrosis index FIB-4 as a model for risk stratification of hepatocellular carcinoma development in predominantly non-Asian patients with chronic hepatitis B infection seen at a tertiary referral center in Germany.We retrospectively analyzed 373 adult patients with chronic hepatitis B infection. Patient demographics, hepatitis B markers, antiviral treatment, laboratory parameters, results from liver imaging and histology were recorded. Patients were divided into 2 groups according to their FIB-4 levels and their hazard ratios for developing hepatocellular carcinoma were analyzed adjusted for age, sex, body mass index, alcohol consumption, and antiviral medication.Median follow-up was 8.7 years (range 1-21.3 years), 93% of patients were of non-Asian origin, and 64% were male. Compared with patients with a low FIB-4 (<1.25) patients with FIB-4 ≥1.25 showed a hazard ratio for incidence of hepatocellular carcinoma of 3.03 (95% confidence interval (CI): 1.24-7.41) and an adjusted hazard ratio of 1.75 (95% CI: 0.64-4.74). Notably, 68% of patients with liver cirrhosis and 68% of those who developed HCC during observation had a low FIB-4 (<1.25).We could not confirm that a FIB-4 value ≥1.25 is a reliable clinical indicator for incidence of hepatocellular carcinoma in predominantly non-Asian patients with chronic hepatitis B. Further studies in geographically and ethnically diverse populations are needed to prove its utility as a predictive tool.
authors.affiliation: Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Münevver
authors.initials: M
authors.lastname: Demir
authors.forename: Friederike
authors.initials: F
authors.lastname: Grünewald
authors.forename: Sonja
authors.initials: S
authors.lastname: Lang
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
authors.forename: Andrea
authors.initials: A
authors.lastname: Bowe
authors.forename: Vera
authors.initials: V
authors.lastname: Mück
authors.forename: Fabian
authors.initials: F
authors.lastname: Kütting
authors.forename: Tobias
authors.initials: T
authors.lastname: Goeser
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Steffen
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016016:Proportional Hazards Models; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D014408:Biomarkers, Tumor; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase