How to better stratify patients at liver risk? The question arises insistently while the steatotic liver disease associated with a metabolic dysfunction (MASLD) keeps gaining ground? If the FIB-4 is used as a first line test, experts point to uncertainties regarding its relevance. Researchers from Karolinska Institutet, Sweden, offer an alternative to this score that they consider little adapted to the general population, where the prevalence of advanced fibrosis is traditionally weak.
“FIB-4 has been initially developed to detect fibrosis in patients who are hidden by HIV and hepatitis C virus”, they recall in a new study published in the BMJ. In addition, they add that “ FIB-4 is very effective in detecting the level of fibrosis at a given moment, but much less to predict future fibrosis ”. However, this information is important to set up prevention and surveillance.
A combination of three blood markers
In this work, the researchers compared the FIB-4 to a new model of predicting the risk of serious liver pathology, called Core (for cirrhosis outcome risk estimator), combining the age, sex and blood rates of aspartate aminotransferase (asat), Alanine aminotransferase (ALAT) and Gamma-Glutamyl Transferase (GGT).
This model was experienced from data from a group of 480,651 patients with no known history of liver pathology, then validated on two other independent cohorts of 24 191 and 449,806 individuals followed during a 28 -year median. The risks of patients were measured with the Core and with the FIB-4 score when they include.
The risk of mischief (composite criterion of decompensated cirrhosis, hepatocellular carcinoma, liver transplant and hepatic cause) was 0.27 % at ten years. The area under the core curve, that is to say its ability to discriminate patients at risk of liver complication, was 88 % against 79 % for FIB-4. Whatever the threshold chosen, the FIB-4 curve was below that of the Core, indicating its slightest reliability to identify patients at risk.
A less expensive test
In addition, the calibration (that is, the ability of the test to quantify the individual risk) was good in the three cohorts for the Core, which had a clear advantage on the FIB-4. This tonet “based on simple biomarkers to obtain in primary care was much more efficient than the FIB-4, summarize the authors. It could be a good way to stratify patients at risk in the general population. »»
A last advantage of the Core is that it is compared cheaper than the FIB-4: 4.88 euros against 10.57 according to an estimate of the researchers. In practice, the measurement of liver markers (ASAT, ALAT, GGT) can be made in a single tube where the FIB-4 requires an additional for platelet count.
The researchers plan to test Core on more diversified cohorts, all the studies carried out so far having been carried out in Western Europe. A reflection would be useful to fix the thresholds to be used, in order to reconcile sensitivity, specificity, but also medico-economic context. Future studies could compare Core to other risk scores such as Liverrisk, Safe or MAF.
