Repeated FIB-4 measurements can help identify individuals at risk of severe liver disease.

Hagström, Hannes; Talbäck, Mats; Andreasson, Anna; Walldius, Göran; Hammar, Niklas

BACKGROUND & AIMS It is unclear as to whether the identification of individuals at risk of cirrhosis using noninvasive tests can be improved by repeated measurements. METHODS Data were derived from the population-based Swedish AMORIS cohort with baseline examinations from 1985-1996. The Fibrosis-4 index (FIB-4) was calculated at two time points within 5 years. Thereafter, we associated changes in FIB-4 with outcomes. Incident severe liver disease was ascertained through linkage with Swedish national registers until 2011. Hazard ratios (HRs) and confidence intervals (CIs) for outcomes were calculated using Cox regression. RESULTS Of 126,942 persons with available FIB-4 data, 40,729 (32.1%) underwent a second test within 5 years (mean interval 2.4 years). During 613,376 person-years of follow-up, 581 events of severe liver disease were documented (0.95/1,000 person-years). An increase of one unit in FIB-4 was associated with an elevated risk of severe liver disease (aHR=1.81, 95%CI=1.67-1.96). Transitioning from a low- or intermediate- to a high-risk group was associated with an increased risk of severe liver disease compared with those consistently in the low-risk group (aHR=7.99 and 8.64, respectively). A particularly increased risk of severe liver disease was found in persons defined as high-risk at both tests (aHR=17.04, 95%CI=11.67-24.88). However, almost half of all events occurred in those consistently in the low-risk group. CONCLUSIONS Repeated testing of FIB-4 within 5 years improves the identification of individuals in the general population at an increased risk of severe liver disease. However, the sensitivity is comparatively low and improved tests are needed for screening in a general population or primary care setting.