The fib-4 index is a useful predictor for the development of hepatocellular carcinoma in patients with coexisting nonalcoholic fatty liver disease and chronic hepatitis b

Minah Kim, Yeonju Lee, Jun Sik Yoon, Minjong Lee, So Shin Kye, Sun Woong Kim, Yuri Cho

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: The FIB-4 index, a noninvasive tool (FIB-4 index = age × aspartate transami-nase (AST)/(platelet count × √alanine aminotransferase (ALT)), is a useful assessment for liver fibro-sis. Patients with a high FIB-4 index were reported to have a high risk of developing hepatocellular carcinoma (HCC). This study analyzed the clinical association of the FIB-4 index with HCC development in patients with coexisting nonalcoholic fatty liver disease and chronic hepatitis B (NAFLD– CHB). Methods: This retrospective study analyzed 237 consecutive patients with NAFLD–CHB between January 2006 and December 2010 at the National Police Hospital in Korea. Patients with HCC at baseline and those diagnosed with HCC within 6 months from baseline were excluded. Propensity score matching analysis (PSM) was adopted to balance the baseline characteristics between patients with low and high FIB-4 index values. The cumulative rates of HCC development were com-pared between the two groups using the Kaplan–Meier method in the matched population. Results: The median follow-up duration was 13 years (interquartile range, 8.2–15.7). The optimal cutoff for the FIB-4 index of 1.77 was calculated based on the maximum Youden index value, with an AUC of 0.70. Among a total of 237 patients with NAFLD–CHB, HCC developed in 20 patients (8.4%) (14 of the 90 patients with a high FIB-4 index vs. 6 of the 147 patients (4.1%) with a low FIB-4 index; log-rank p = 0.003). Patients with a high FIB-4 index had a significantly and independently higher risk of HCC than those with a low FIB-4 index (adjusted hazard ratio, 4.35; 95%; confidence interval, 1.42–13.24; log-rank test, p = 0.006). Conclusion: A high FIB-4 index (≥1.77) might be a useful marker for predicting the development of HCC in patients with NAFLD–CHB.

Original languageEnglish
Article number2301
JournalCancers
Volume13
Issue number10
DOIs
StatePublished - 2 May 2021

Bibliographical note

Funding Information:
Funding: This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI21C0240) and the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIT) (2021R1A2C4001401).

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Chronic hepatitis B
  • FIB-4
  • Hepatocellular carcinoma
  • Nonalcoholic fatty liver disease
  • Predictor

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