ArticleJournal of general internal medicine2023
Real-World Primary Care Data Comparing ALT and FIB-4 in Predicting Future Severe Liver Disease Outcomes.
Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Albuminuria and Metabolic Dysfunction-Associated Steatotic Liver Disease with Advanced Fibrosis in Primary Care.Metabolic syndrome and related disorders · 2026Article
- Association of the fibrosis-4 index with prevalent diabetes among adults: a cross-sectional analysis of NHANES 2003-2018 and a Chinese hospital-based health examination population.Frontiers in endocrinology · 2026Article
- Development and validation of bleeding prediction model for percutaneous liver biopsy in children.BMC pediatrics · 2025Article
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- 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
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAlanine aminotransferase (ALT) has long provided a cue for chronic liver disease (CLD) diagnostic evaluation, but the Fibrosis-4 Index (FIB-4), a serologic score used for predicting advanced fibrosis risk in CLD, may provide an alternative signal.
objectiveCompare the predictive performance of FIB-4 with ALT for severe liver disease (SLD) events while adjusting for potential confounders.
designRetrospective cohort study of primary care electronic health record data from 2012 to 2021. PATIENTS: Adult primary care patients with at least two sets of ALT and other lab values necessary for calculating two unique FIB-4 scores, excluding those patients with an SLD prior to their index FIB-4 value. MAIN MEASURES: The occurrence of an SLD event, a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation, was the outcome of interest. Categories of ALT elevation and FIB-4 advanced fibrosis risk were the primary predictor variables. Multivariable logistic regression models were developed to evaluate the association of FIB-4 and ALT with SLD, and the areas under the curve (AUC) for each model were compared. KEY
resultsThe cohort of 20,828 patients included 14% with an abnormal index ALT (≥40 IU/L) and 8% with a high-risk index FIB-4 (≥2.67). During the study period, 667 (3%) patients suffered an SLD event. Adjusted multivariable logistic regression models demonstrated an association between high-risk FIB-4 (OR 19.34; 95%CI 15.50-24.13), persistently high-risk FIB-4 (OR 23.85; 95%CI 18.24-31.17), abnormal ALT (OR 7.07; 95%CI 5.81-8.59), and persistently abnormal ALT (OR 7.58; 95%CI 5.97-9.62) with SLD outcomes. The AUC of the index FIB-4 (0.847, p < 0.001) and combined FIB-4 (0.849, p < 0.001) adjusted models exceeded the index ALT adjusted model (0.815).
conclusionsHigh-risk FIB-4 scores demonstrated superior performance compared to abnormal ALT in predicting future SLD outcomes.
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