ArticleLiver international : official journal of the International Association for the Study of the Liver2023
FIB-4 and incident severe liver outcomes in patients with undiagnosed chronic liver disease: A Fine-Gray competing risk analysis.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 23 citations in OpenAlex.
- Trial
- Steatotic liver disease indices for cardiovascular event prediction: Panasonic cohort study 28.American journal of preventive cardiology · 2026Article
- Risk of total and cause-specific mortality in patients with rheumatoid arthritis-associated interstitial lung disease or bronchiectasis.Rheumatology (Oxford, England) · 2025Article
- Development and validation of machine learning models to predict esophagogastric variceal rebleeding risk in HBV-related cirrhosis after endoscopic treatment: a prospective multicenter study.EClinicalMedicine · 2025Article
- Associations of Serum Vitamin D with Sarcopenia in Patients with Chronic Liver Disease: A Population-Based Cross-Sectional Study.Calcified tissue international · 2025Article
- Evolving epidemiology of HCC in Spain.JHEP reports : innovation in hepatology · 2025Article
- Article
- Objective Measures of Cardiometabolic Risk and Advanced Fibrosis Risk Progression in Primary Care Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2024Article
- Statin prescriptions and progression of advanced fibrosis risk in primary care patients with MASLD.BMJ open gastroenterology · 2024Article
- Using the FIB-4, automatically calculated, followed by the ELF test in second line to screen primary care patients for liver disease.Scientific reports · 2024Article
- Observational
- Review
- Real-World Primary Care Data Comparing ALT and FIB-4 in Predicting Future Severe Liver Disease Outcomes.Journal of general internal medicine · 2023Article
- Environmental exposures are important risk factors for advanced liver fibrosis in African American adults.JHEP reports : innovation in hepatology · 2023Article
- How to Identify Advanced Fibrosis in Adult Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) Using Ultrasound Elastography-A Review of the Literature and Proposed Multistep Approach.Diagnostics (Basel, Switzerland) · 2023Review
- A higher FIB-4 index is associated with an increased incidence of renal failure in the general population.Hepatology communications · 2022Article
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
BACKGROUND AND
aimsThe Fibrosis-4 index (FIB-4) can reliably assess fibrosis risk in patients with chronic liver disease, and advanced fibrosis is associated with severe liver disease (SLD) outcomes. However, CLD is underdiagnosed in primary care. We examined the association between FIB-4 risk strata and the incidence of SLD preceding a CLD diagnosis while considering incident CLD diagnoses as competing risks.
methodsUsing primary care clinic data between 2007 and 2018, we identified patients with two FIB-4 scores and no liver disease diagnoses preceding the index FIB-4. Patients were followed from index FIB-4 until an incident SLD (a composite of cirrhosis, hepatocellular carcinoma or liver transplantation), CLD or were censored. Hazard ratios were computed using a Fine-Gray competing risk model.
resultsOf 20 556 patients, there were 54.8% in the low, 34.8% in the indeterminate, 6.6% in the high and 3.8% in the persistently high-risk FIB-4 strata. During a mean 8.2 years of follow-up, 837 (4.1%) patients experienced an SLD outcome and 11.5% of the sample received a CLD diagnosis. Of patients with an SLD event, 49% received no preceding CLD diagnosis. In the adjusted Fine-Gray model, the indeterminate (HR 1.41, 95% CI 1.17-1.71), high (HR 4.65, 95% CI 3.76-5.76) and persistently high-risk (HR 7.60, 95% CI 6.04-9.57) FIB-4 risk strata were associated with a higher incidence of SLD compared to the low-risk stratum.
conclusionsFIB-4 scores with indeterminate- and high-risk values are associated with an increased incidence of SLD in primary care patients without known CLD.
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