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High liver fibrosis index FIB‐4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers
Author(s) -
Suh Beomseok,
Park Sehhoon,
Shin Dong Wook,
Yun Jae Moon,
Yang HyungKook,
Yu Su Jong,
Shin CheongIl,
Kim JinSoo,
Ahn Eunmi,
Lee Hyejin,
Park Jin Ho,
Cho BeLong
Publication year - 2015
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.27654
Subject(s) - medicine , hepatocellular carcinoma , interquartile range , hazard ratio , cirrhosis , hbsag , gastroenterology , hepatitis b , incidence (geometry) , hepatitis c , confidence interval , oncology , hepatitis b virus , immunology , virus , physics , optics
Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB‐4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow‐up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB‐4 <1.25, subjects with 1.7≤ FIB‐4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50‐13.92) and subjects with FIB‐4 ≥2.4 showed an aHR of 21.34 (95% CI: 7.73‐58.92) for HCC incidence. FIB‐4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C‐index: 0.701 vs. 0.831; P = 0.001). FIB‐4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C‐index: 0.775 vs. 0.701; P = 0.040). Conclusion : High FIB‐4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB‐4 is a promising, easily applicable, and cost‐effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB‐4 may play a valuable role in HCC screening among HBsAg carriers. (H epatology 2015;61:1261–1268)