B0487 - Role of FIB-4 Score in Predicting Risk of Hepatocellular Carcinoma in Patients With Cirrhosis due to Nonalcoholic Steatohepatitis

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Somaya Albhaisi, MBBCh, MD

Virginia Commonwealth University
Richmond, VA

Somaya Albhaisi, MBBCh, MD¹, Jing Sun, MD, PhD²
¹Virginia Commonwealth University, Richmond, VA; ²Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Introduction: Hepatocellular carcinoma (HCC) represents the main cause of death in patients with nonalcoholic steatohepatitis (NASH) cirrhosis and is a leading indication for liver transplantation. Identification of high-risk patients for HCC is essential for long term monitoring of disease progression, early detection, and effective intervention. Fibrosis-4 (FIB-4) is a noninvasive index of readily available laboratory measurements and is widely validated for predicting cirrhosis and HCC. We sought to determine if FIB-4 score is associated with high risk of HCC among patients with NASH cirrhosis.

Methods: We conducted a retrospective cohort study of adult patients with NASH cirrhosis (n=1,441) who were evaluated at our medical center between 2005 and 2015. Those who developed HCC were identified via ICD codes until the end of September 2021. At day of index NASH cirrhosis diagnosis, clinical and biochemical measurements were recorded on each patient. Descriptive statistics were calculated for all factors. Kaplan-Meier analysis was performed to evaluate time to HCC event. Cox regression models were used to evaluate associations between HCC and factors of interest. Models were adjusted for age, sex, number of comorbidities, and laboratory values.

Results: During a median follow-up time of 8.3 years, 218 (15%) patients with NASH cirrhosis developed HCC. At index visit, the study population had a median age 57 years, 44% males, 78.6% White, median BMI 31.5 kg/m², 26.7% had diabetes mellitus, 10.4% current smokers, mean FIB-4 score 4.2, and mean MELD score 8.1. Multivariable Cox regression models revealed that age, sex, race/ethnicity, BMI and FIB-4 were independent factors associated with development of HCC in patients with NASH cirrhosis (table 1). Compared to patients with FIB-4 < 1.45, patients with FIB-4 between 1.45-3.25 had a similar risk of HCC (95% CI: 0.61-1.86, p=0.82). Patients with FIB-4 > 3.25 had a 2.51 (95% CI: 1.53-4.12, p< 0.001) increased hazard of HCC (figure 1).

Discussion: Age, sex, race/ethnicity, BMI and FIB-4 were independently associated with HCC in NASH cirrhosis. We found that FIB-4 > 3.25 was an independent predictor of HCC risk. Providers should pay attention to FIB-4 for long term monitoring of disease progression. An inexpensive, available, validated marker like FIB-4 is a promising tool for identification of high-risk patients and may be used in routine clinical practice as a simple screening strategy for HCC risk in patients with NASH cirrhosis.

Figure: Kaplan-Meier estimates of developing HCC in patients with NASH cirrhosis by FIB-4 score within 5 years of follow up.

	Univariate		Multivariable
Factors	Unadjusted Hazard Ratio (95% Confidence Interval)	p-value	Adjusted Hazard Ratio (95% Confidence Interval)	p-value
Age group, yrs
<49	1 [reference]		1 [reference]
>49-59	1.40 (0.96-2.04)	0.08	1.22 (0.74-2.04)	0.43
>59-69	2.13 (1.47-3.11)	0.000	1.72 (1.02-2.90)	0.04
>69	4.26 (2.66-6.80)	0.000	3.03 (1.57-5.88)	0.001
Sex
Female	1 [reference]		1 [reference]
Male	2.13 (1.62-2.8)	0.000	2.00 (1.37-2.91)	0.000
Race and ethnicity
Hispanic	0.72 (0.29-1.7)	0.46	0.42 (0.10-1.74)	0.23
Non-Hispanic
White	1 [reference]		1 [reference]
Black	0.62 (0.42-0.91)	0.01	0.70 (0.43-1.13)	0.15
Other*	0.59 (0.19-1.8)	0.36	0.50 (0.12-2.06)	0.34
BMI, Kg/m2	0.989 (0.97-1.01)	0.24
BMI category, Kg/m2
< 18.5	0.95 (0.22-4.16)	0.95	1.52 (0.34-6.85)	0.59
18.5–24.9	1 [reference]		1 [reference]
25.0–29.9	1.73 (0.96-3.11)	0.07	1.69 (0.89-3.20)	0.11
30.0–34.9	1.49 (0.81-2.7)	0.20	1.46 (0.76-2.81)	0.26
35.0–39.9	1.59 (0.83-3.02)	0.16	1.63 (0.82-3.26)	0.16
>40	0.95 (0.47-1.91)	0.89	1.16 (0.53-2.50)	0.71
Diabetes	0.76 (0.55-1.06)	0.11
Total cholesterol, mg/dL
125-200	1 [reference]
>200	0.78 (0.39-1.6)	0.50
LDL, mg/dL
< 130	1 [reference]
>130	0.42 (0.17-1.01)	0.05
MELD score
<20	1 [reference]
>20	1.14 (0.60-2.16)	0.68
FIB-4 score
< 1.45	1 [reference]		1 [reference]
1.45-3.25	1.22 (0.79-1.9)	0.37	1.07 (0.61-1.86)	0.82
> 3.25	2.74 (1.89-3.97)	0.000	2.51 (1.53-4.12)	0.000
Albumin, g/dL	0.685 (0.566-0.828)	0.000
INR	1.52 (1.19-1.95)	0.001
Creatinine, mg/dL	0.91 (0.77-1.07)	0.26
Total Bilirubin, mg/dL	1.04 (1.01-1.07)	0.01
Platelet count, x10⁹/L	0.997 (0.996-0.999)	0.001

*Other category included Asian, American Indian-Alaskan or other.

Table: Factors Associated with HCC in NASH Cirrhosis: Univariate and Multivariable Analyses.

Disclosures:

Somaya Albhaisi indicated no relevant financial relationships.

Jing Sun indicated no relevant financial relationships.

Somaya Albhaisi, MBBCh, MD¹, Jing Sun, MD, PhD². B0487 - Role of FIB-4 Score in Predicting Risk of Hepatocellular Carcinoma in Patients With Cirrhosis due to Nonalcoholic Steatohepatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.