FIB-4 as a Time-varying Covariate and Its Association With Severe Liver Disease in Primary Care: A Time-dependent Cox Regression Analysis.

IF 2.8 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of clinical gastroenterology Pub Date : 2024-10-01 DOI:10.1097/MCG.0000000000001935
Andrew D Schreiner, Jingwen Zhang, William P Moran, David G Koch, Justin Marsden, Sherry Livingston, Chloe Bays, Patrick D Mauldin, Mulugeta Gebregziabher
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Abstract

Background and goals: The Fibrosis-4 Index (FIB-4) has demonstrated a strong association with severe liver disease (SLD) outcomes in primary care, but previous studies have only evaluated this relationship using 1 or 2 FIB-4 scores. In this study, we determined the association of FIB-4 as a time-varying covariate with SLD risk using time-dependent Cox regression models.

Study: This retrospective cohort study included primary care patients with at least 2 FIB-4 scores between 2012 and 2021. The outcome was the occurrence of an SLD event, a composite of cirrhosis, complications of cirrhosis, hepatocellular carcinoma, and liver transplantation. The primary predictor was FIB-4 advanced fibrosis risk, categorized as low-(<1.3), indeterminate-(1.3≤FIB to 4<2.67), and high-risk (≥2.67). FIB-4 scores were calculated and the index, last, and maximum FIB-4s were identified. Time-dependent Cox regression models were used to estimate hazard ratios (HR) and their corresponding 95% CI with adjustment for potentially confounding covariates.

Results: In the cohort, 20,828 patients had a median of 5 (IQR: 3 to 11) FIB-4 scores each and 3% (n=667) suffered an SLD outcome during follow-up. Maximum FIB-4 scores were indeterminate-risk for 34% (7149) and high-risk for 24% (4971) of the sample, and 32% (6692) of patients had an increase in fibrosis risk category compared with their index value. The adjusted Cox regression model demonstrated an association between indeterminate- (hazard ratio 3.21; 95% CI 2.33-4.42) and high-risk (hazard ratio 20.36; 95% CI 15.03-27.57) FIB-4 scores with SLD outcomes.

Conclusions: Multiple FIB-4 values per patient are accessible in primary care, FIB-4 fibrosis risk assessments change over time, and high-risk FIB-4 scores (≥2.67) are strongly associated with severe liver disease outcomes when accounting for FIB-4 as a time-varying variable.

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FIB-4作为时变协变量及其与初级保健中严重肝脏疾病的关联:时变Cox回归分析
背景和目的:在初级保健中,纤维化-4指数(FIB-4)已经证明与严重肝脏疾病(SLD)的预后有很强的相关性,但之前的研究仅使用1或2个FIB-4评分来评估这种关系。在本研究中,我们使用时变Cox回归模型确定FIB-4作为时变协变量与SLD风险的关联。研究:这项回顾性队列研究纳入了2012年至2021年间FIB-4评分至少为2分的初级保健患者。结果是SLD事件的发生,肝硬化、肝硬化并发症、肝细胞癌和肝移植的复合。主要预测因子是FIB-4晚期纤维化风险,分类为低(结果:在队列中,20,828例患者FIB-4评分中位数为5 (IQR: 3至11),3% (n=667)在随访期间出现SLD结局。最大FIB-4评分为不确定评分,34%(7149)为高危评分,24%(4971)为高危评分,32%(6692)患者的纤维化风险类别与其指数值相比有所增加。调整后的Cox回归模型显示,不确定风险比为3.21;95% CI 2.33-4.42)和高风险(风险比20.36;(95% CI 15.03-27.57) FIB-4评分与SLD结局相关。结论:在初级保健中,每位患者可获得多个FIB-4值,FIB-4纤维化风险评估随时间变化,当将FIB-4作为时变变量考虑时,高风险FIB-4评分(≥2.67)与严重肝病结局密切相关。
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来源期刊
Journal of clinical gastroenterology
Journal of clinical gastroenterology 医学-胃肠肝病学
CiteScore
5.60
自引率
3.40%
发文量
339
审稿时长
3-8 weeks
期刊介绍: Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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