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    Home > Active Ingredient News > Digestive System Information > FIB-4 Index: It can predict the risk of liver cancer in patients with chronic hepatitis B after antiviral treatment

    FIB-4 Index: It can predict the risk of liver cancer in patients with chronic hepatitis B after antiviral treatment

    • Last Update: 2021-04-17
    • Source: Internet
    • Author: User
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    FIB-4 Index (Fibrosis 4 Score)?

    FIB-4 Index (Fibrosis 4 Score)?

    This is a non-invasive method for evaluating liver fibrosis in patients with chronic liver disease, because it does not require additional examinations, only a few values ​​on the physical examination sheet need to be substituted into the formula for calculation.
    The values ​​that need to be used include age, ALT (alanine aminotransferase), AST (aspartate aminotransferase), and PLT (platelets).
    The Metz Medical website also provides quick calculation procedures.
    See:
    FIB-4 index of liver fibrosis in patients with chronic liver disease

    FIB-4 index of liver fibrosis in patients with chronic liver disease

    The calculation formula of FIB-4 index is:

    FIB-4=Age×AST/PLT count×√ALT
    FIB-4=age×AST/PLT count×√ALT FIB-4=age×AST/PLT count×√ALT FIB-4=age×AST/PLT count×√ALT FIB-4=age×AST/PLT count× √ALT

    The critical value of FIB-4 index evaluation for different liver diseases is slightly different.
    For chronic hepatitis B or C, patients with FIB-4 index <1.
    45 have no obvious liver fibrosis or only liver fibrosis below grade 2, and the coincidence rate with liver puncture virology results is 94.
    7%; while FIB-4 index The degree of liver fibrosis in patients with> 3.
    25 was grade 3 to 4 or above, and the coincidence rate with the virological results of liver puncture was 82.
    1%.
    For non-alcoholic fatty liver, the critical index of liver fibrosis below grade 2 or above grade 3 to 4 is <1.
    3 and >2.
    67, respectively.
    However, there are also studies that believe that the FIB-4 index is more accurate in ruling out obvious liver fibrosis and is better than the diagnosis of severe liver fibrosis.
    Clinically, the FIB-4 index is better than the APRI score in predicting significant fibrosis and liver cirrhosis, and it can replace liver biopsy to a certain extent.

    1.
    The FIB-4 index can be used to predict the risk of HCC in patients with chronic hepatitis B (CHB)

    1.
    The FIB-4 index can be used to predict the risk of HCC in patients with chronic hepatitis B (CHB)

    It is well known that the occurrence of hepatocellular carcinoma (HCC) is the result of the progression of liver fibrosis.
    Therefore, it is very important to determine the advanced stage of liver fibrosis early.
    A study published by Korean researchers showed that non-invasive fibrosis-4 (FIB-4) index [based on age, aspartate aminotransferase (AST), platelet count (PLT) and alanine aminotransferase (ALT) level] can be used to predict the risk of HCC in patients with chronic hepatitis B (CHB), which is better than AST and PLT ratio index (APRI) or glutamyl transpeptidase (GGT) and PLT ratio (GPR).

    The study included a total of 444 CHB patients who underwent liver biopsy and serological liver fibrosis marker testing.
    All patients were followed up to monitor the occurrence of HCC, using histological fibrosis staging as a reference to evaluate FIB-4, APRI and The predictive value of GPR on the risk of HCC in CHB patients.

    As a result, histological fibrosis staging has the highest predictive value for the risk of HCC at 5 and 7 years [area under the receiver operating characteristic curve (AUROC) 0.
    783 and 0.
    766, respectively], followed by FIB-4 (predicted 5 years and The AUROC for the risk of HCC at 7 years is 0.
    753 and 0.
    698), APRI (the AUROC for predicting the risk of HCC at 5 and 7 years is 0.
    658 and 0.
    572, respectively) and GPR (the AUROC for predicting the risk of HCC at 5 and 7 years) 0.
    638 and 0.
    603 respectively).

    According to histological fibrosis stage (F4 vs.
    F0-3) and FIB-4 index (FIB-4 ≥ 3.
    25 vs.
    FIB-4 <3.
    25), the patients are divided into risk groups.
    The risk of HCC in the high-risk group is significantly higher than that in the low-risk group (
    P values ​​are 0.
    005 and 0.
    022, respectively).

    P

    2.
    Repeated sampling and calculation of FIB-4 index can increase the prediction of future liver cirrhosis

    2.
    Repeated sampling and calculation of FIB-4 index can increase the prediction of future liver cirrhosis

    Another study showed that by repeatedly sampling and calculating the FIB-4 index, rather than just measuring it once, the prediction of future liver cirrhosis can be increased.
    The researchers used a very large laboratory test database between 1985 and 1996, and obtained FIB-4 blood test data of 126,942 people from multiple sampling occasions to identify those who developed liver cirrhosis in 27 years .

    The results showed that 40,729 people (32.
    1%) underwent the second test within 5 years (average interval of 2.
    4 years).
    A total of 581 serious liver disease events were recorded during the follow-up period.
    Therefore, the increase in the
    FIB-4 index over time is related to the risk of severe liver disease ; and repeated FIB-4 tests can help identify those who are at risk of severe liver disease-in the two tests, an increase in the FIB-4 index represents the risk An increase and a decrease represent a decrease in risk.
    However, it is worth noting that according to the literature, the specificity of adult FIB-4 index>3.
    6 in
    diagnosing liver cirrhosis is 87%, and the sensitivity is 45%.
    In other words, accuracy is still a problem for this examination.
    In this study,
    about 50 % of people who will be affected by cirrhosis in the future can be identified
    through the FIB-4 index .

    FIB-4 index increased risks associated with severe liver disease diagnosis by FIB-4 index can identify about 5 0% of the future by cirrhosis of the liver affected people

    Researchers say it takes a long time to develop liver cirrhosis.
    The results show that the FIB-4 index can identify high-risk groups of severe liver disease and exclude healthy people.
    It is usually sufficient to recalculate the FIB-4 index at intervals of several years.
    However, this method still needs to be further improved to reduce the risk of false positive results.

    3.
    The FIB-4 index can predict the risk of liver cancer in patients with chronic hepatitis B after antiviral treatment.

    3.
    The FIB-4 index can predict the risk of liver cancer in patients with chronic hepatitis B after antiviral treatment.

    Fibrosis-4 (FIB-4) index can assess the degree of liver fibrosis in patients with chronic hepatitis B (CHB) and is also a predictor of the risk of hepatocellular carcinoma (HCC).
    However, it is similar to long-term acceptance of nucleotides (acids) It is unclear whether the FIB-4 value can help determine the patients with the lowest risk of HCC in CHB patients without liver cirrhosis treated with NA.

    A study recently published by National Taiwan University School of Medicine and National Taiwan University Hospital Tseng, etc.
    showed that for CHB patients without cirrhosis who received long-term NA treatment, the FIB-4 value at 1 year of treatment was less than 1.
    30, combined with gender as female or PAGE -B (based on age, gender, and platelet count at baseline) has a low score, which helps to identify patients with the lowest risk of HCC.

    This retrospective multinational study included a total of 1936 CHB patients of different races and without cirrhosis.
    All patients received long-term NA treatments such as entecavir or tenofovir.
    The cut-off value of FIB-4 was 1.
    30 (indicating mild liver fibrosis).
    The cut-off point value) can be used to stratify the HCC risk of these patients.

    As a result, during an average follow-up of 6.
    98 years, a total of 48 patients developed HCC.
    The FIB-4 value at 1 year of treatment is significantly related to the risk of HCC, and the predictive value of the risk of HCC is better than the FIB-4 value before treatment.
    Stratified according to whether the FIB-4 value at 1 year of treatment was more than 1.
    30, compared with the low FIB-4 group, the risk of HCC was significantly increased in the high FIB-4 group (hazard ratio: 4.
    87, 95% confidence interval: 2.
    48 -9.
    55).

    Multivariate analysis showed that the patient’s gender and FIB-4 at 1 year of treatment were independent predictors of the risk of HCC.
    Among the 314 female patients with low FIB-4 at 1 year of treatment, there was no HCC.

    Finally, for patients with a low PAGE-B score, combined with whether the FIB-4 value at 1 year of treatment exceeds 1.
    30, the risk of HCC can be stratified.
    The PAGE-B score is <10, and the FIB-4 value at 1 year of treatment is < 1.
    30 patients have the lowest risk of HCC, and the annual incidence of HCC is only 0.
    11%.

    FIB-4 online use: FIB-4 index of liver fibrosis in patients with chronic liver disease

    FIB-4 Index of Liver Fibrosis in Patients with Chronic Liver Diseases FIB-4 Index of Liver Fibrosis in Patients with Chronic Liver Diseases

    references:

    Kim MN, Lee JH, Chon YE, et al.
    Fibrosis-4, aspartate transaminase-to-platelet ratio index, and gamma-glutamyl transpeptidase-to-platelet ratio for risk assessment of hepatocellular carcinoma in chronic hepatitis B patients: comparison with liver biopsy.
    Eur J Gastroenterol Hepatol.
    2019 Sep 3.

    Hannes Hagström, Mats Talbäck, Anna Andreasson, Göran Walldius, Niklas Hammar.
    Repeated FIB-4 measurements can help identify individuals at risk of severe liver disease.
    Journal of Hepatology, 2020; DOI: 10.
    1016/j.
    jhep.
    2020.
    06.
    007

    Tseng TC, Choi J, Nguyen MH, et al.
    One-year Fibrosis-4 index helps identify minimal HCC risk in non-cirrhotic chronic hepatitis B patients with antiviral treatment.
    Hepatol Int.
    2021 Feb;15(1):105-113 .



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