ArticleBMJ open gastroenterology2025
Non-invasive liver fibrosis scores and mortality in a cohort of World Trade Center rescue/recovery workers.
Article in BMJ open gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesHigher liver fibrosis scores have been associated with all-cause and liver disease-related mortality. We investigated whether liver fibrosis scores were associated with all-cause, liver disease-related and non-liver disease-related mortality and liver cancer incidence in an occupational cohort.
methodsThe study included 43 870 Combined World Trade Center Rescue/Recovery Worker Cohort members who had blood drawn between 11/9/2001-31/12/2020. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 score (FIB-4), and non-alcoholic fatty liver disease fibrosis score (NFS) were calculated and categorised as low, intermediate or high scores per established cut-offs. Deaths and liver cancers were identified via National Death Index records and state cancer registries. Cox proportional hazards regression models estimated HRs and 95% CIs for each outcome in those with intermediate and high versus low fibrosis scores.
resultsBy 31/12/2020, 1996 deaths, 81 liver disease-related deaths and 36 incident liver cancers occurred. Participants with intermediate or high APRI (HR=1.73, 95% CI 1.50 to 1.99 and HR=7.23, 95% CI 5.63 to 9.29), FIB-4 (HR=1.18, 95% CI 1.05 to 1.34 and HR=3.96, 95% CI 3.22 to 4.85) or NFS (HR=1.61, 95% CI 1.43 to 1.81 and HR=4.73, 95% CI 3.78 to 5.93) had increased risks of all-cause mortality vs those with low scores, controlling for potential confounders. Those with intermediate/high scores also had increased liver disease- and non-liver disease-related mortality. High APRI, FIB-4 and NFS, and intermediate APRI and NFS were associated with liver cancer.
conclusionsIntermediate and high liver fibrosis scores predicted all-cause, liver disease-related and non-liver disease-related mortality, and high scores predicted liver cancer, in this population. Liver fibrosis scores may identify those at greater risk for poor health outcomes, even in a healthy occupational cohort.
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