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Utility of the FIB ‐4 Index for hepatocarcinogenesis in hepatitis C virus carriers with normal alanine aminotransferase levels
Author(s) -
Ito T.,
Kumada T.,
Toyoda H.,
Tada T.,
Kiriyama S.,
Tanikawa M.,
Hisanaga Y.,
Kanamori A.,
Kitabatake S.
Publication year - 2015
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12389
Subject(s) - alanine aminotransferase , alanine , chemistry , index (typography) , hepatitis a virus , hepatitis c virus , virology , cancer research , medicine , virus , biochemistry , computer science , amino acid , world wide web
Summary The FIB‐4 index is a simple formula using age, aspartate aminotransferase, alanine aminotransferase (ALT) and platelet count to evaluate liver fibrosis. We investigated the ability of the FIB‐4 index for hepatocarcinogenesis in hepatitis C virus (HCV) carriers with normal ALT levels. A total of 516 patients with ALT levels persistently at or below 40 IU/L during an observation period of over 3 years were included. Factors associated with the development of HCC were determined. Hepatocellular carcinoma (HCC) developed in 60 of 516 patients (11.6%). The incidence rate of HCC at 5 and 10 years was 2.6% and 17.6%, respectively. When patients were categorized according to the FIB‐4 index as ≤2.0 ( n = 226), >2.0 and ≤4.0 ( n = 169), and >4.0 ( n = 121), the cumulative incidence of HCC at 5 years was 0.5%, 1.3% and 8.0%, respectively, and 2.8%, 25.6% and 37.1% at 10 years, respectively. Patients with FIB‐4 index >4.0 were at the highest risk ( P < 0.001). Factors that were significantly associated with HCC in the multivariate analysis were FIB‐4 index >2.0 (hazard ratio (HR), 7.690), FIB‐4 index >4.0 (HR, 8.991), α‐fetoprotein (AFP) >5 ng/mL (HR, 2.742), AFP >10 ng/mL (HR, 4.915) and total bilirubin >1.2 mg/dL (HR, 2.142). A scoring system for hepatocarcinogenesis that combines the FIB‐4 index and AFP predicted patient outcomes with excellent discriminative ability. The FIB‐4 index is strongly associated with the risk of HCC in HCV carriers with normal ALT levels.