title: FIB-4 and imaging for measuring fibrosis in hepatitis C virus.
abstract: OBJECTIVE
  Noninvasive measures are widely used to assess fibrosis and may be used to prioritize hepatitis C virus (HCV) treatment. We examined risks for likely fibrosis in patients with chronic HCV infection using fibrosis-4 (FIB-4) and imaging.
  
  
  METHODS
  A HCV screening program diagnosed chronic HCV in patients born from 1945 to 1965 admitted in a safety net hospital. Likely fibrosis was based on FIB-4 (≥1.45) alone or combined with imaging interpreted as fibrosis or cirrhosis. Logistic regression was used to calculate adjusted odds ratios (AORs) for demographic, clinical, and insurance factors associated with each outcome. Using multiple linear regression among patients with likely fibrosis, we examined associations with higher Model for End-Stage Liver Disease (MELD) scores.
  
  
  RESULTS
  Using FIB-4 alone, 57% (83/146) of patients had likely fibrosis versus 43% (63/148) using FIB-4 plus imaging. Obesity/overweight and Hispanic ethnicity had over three-fold to four-fold higher AORs for fibrosis, respectively, based on FIB-4 plus imaging, but both AORs were only two-fold greater with FIB-4 alone. Being uninsured was significantly associated with fibrosis based on FIB-4 alone [AOR=2.40 (95% confidence interval 1.01-5.70)] but not with imaging. Heavy alcohol use and older age were associated with higher AORs of fibrosis with both measures (all P<0.004). MELD scores were ∼3 points higher for uninsured patients, regardless of measure (both P<0.05).
  
  
  CONCLUSIONS
  Using FIB-4 plus imaging to identify fibrosis in chronic HCV, higher risks are seen for Hispanics and overweight/obese individuals than using FIB-4 alone. Higher MELD scores at diagnosis for the uninsured indicate delayed access to care.
authors.affiliation: Departments of aMedicine bEpidemiology and Biostatistics cCenter for Research to Advance Community Health (ReACH), University of Texas Health Science Center (UTHSCSA), San Antonio dDepartment of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liang
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
mesh_terms: D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000428:Alcohol Drinking / Q000453:epidemiology; D001219:Aspartate Aminotransferases / Q000097:blood*; D058625:End Stage Liver Disease; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D010976:Platelet Count; D018570:Risk Assessment; D064876:Safety-net Providers; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase