FIB-4 score predicts ESLD onset in healthy adults

The Fibrosis-4 Index (FIB-4) score can be used to predict the risk of end-stage liver disease (ESLD) in young healthy adults, suggests a study.

A nationwide community and hospital database was used for this retrospective study, which included young adults (aged 18‒40 years), with a FIB-4 score calculated during 2005‒2020. Those with liver metastasis or chronic liver disease, other than metabolic dysfunction-associated steatotic liver disease (MASLD), before or during the study, were excluded.

The first diagnosis of cirrhosis, cirrhosis-related complications, or hepatocellular carcinoma served as the primary outcome. The authors used Cox proportional models, with FIB-4 score categorized by percentiles.

A total of 430 incident ESLD cases in 11,057,421 person-years (mean age at diagnosis 30.0 years) were included in the analysis. FIB-4 score significantly correlated with incident ESLD.

Following the adjustments for several confounders, individuals with FIB-4 in the 75th–94th, 95th–98th, and ≥99th percentiles had 35-percent, 140-percent, and 760-percent greater likelihood of developing ESLD, respectively, compared with those whose FIB-4 score were in the 5th‒49th percentiles.

Notably, each point of the FIB-4 score elicited a 2.2-fold higher risk of incident ESLD (adjusted hazard ratio, 2.21, 95 percent confidence interval, 1.91‒2.56).

“MASLD is highly prevalent and underdiagnosed among young healthy adults, with or without metabolic syndrome,” the authors said.