Not all liver diseases are equal when it comes to FIB-4
A new study found that the widely used Fibrosis-4 index, which estimate liver scarring, was less accurate for people with alcohol-related liver disease by itself.
Even so, the scoring appears to work reasonably well for other types of liver disease where alcohol is involved.
The multinational research, led by hepatologists at Virginia Commonwealth University and the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, focused on two common liver conditions: metabolic dysfunction–associated and alcohol-associated liver disease (MetALD) and alcohol-associated liver disease (ALD). The researchers noted that FIB-4 hasn’t been studied as much in MetALD and ALD as in steatotic liver disease.
Published in Hepatology Communications, the study used liver biopsy and vibration-controlled transient elastography to assess scarring and liver damage. The team looked at a common two-step approach clinicians use to sort patients by risk: doctors typically start with FIB-4 scoring, which is calculated from routine bloodwork. If results are unclear, they follow up with a liver scan. The goal is to identify people who may have advanced scarring, meaning stage F3 or higher.
Among the 893 participants, about 41% had MetALD and 59% had ALD. Advanced fibrosis was fairly common overall, seen in about 45% of participants, though it was lower in MetALD (32%) and higher in ALD (54%).
Performance differed between the two groups. In MetALD, FIB-4’s blood-test results worked well enough to flag advanced scarring in many patients. But in ALD, FIB-4 was significantly less accurate.
The researchers also evaluated the full two-step pathway. Even when clinicians used both steps, some advanced fibrosis cases were still missed. The “false-negative” rate, in which patients were incorrectly labeled as low risk, was 6.8% overall: 4.9% in MetALD and more than double that (11.3%) in ALD.
Overall, the study suggests the standard two-step approach may be fairly effective for MetALD, but it can miss a meaningful number of people with advanced fibrosis in ALD. That points to a need for improved or different noninvasive options for people with alcohol-associated liver disease.
Postdoctoral fellow Hyundam Gu, M.D., was first author on the paper. The institute’s director of alcohol sciences, Juan Pablo Arab, M.D., led the work, on which the director, Arun Sanyal, M.D., and chief clinical officer Richard Sterling, M.D., were co-authors.