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Gabriel-Medina P, Ferrer-Costa R, Ciudin A, Augustin S, Rivera-Esteban J, Pericàs JM, Selva DM, Rodriguez-Frias F. Accuracy of a sequential algorithm based on FIB-4 and ELF to identify high-risk advanced liver fibrosis at the primary care level. Intern Emerg Med 2024; 19:745-756. [PMID: 37952070 PMCID: PMC11039533 DOI: 10.1007/s11739-023-03441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/21/2023] [Indexed: 11/14/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, and liver fibrosis is the strongest predictor of morbimortality. We aimed to assess the performance of a sequential algorithm encompassing the Fibrosis 4 (FIB-4) and Enhanced Liver Fibrosis (ELF) scores for identifying patients at risk of advanced fibrosis. This cross-sectional study included one hospital-based cohort with biopsy-proven NAFLD (n = 140) and two primary care cohorts from different clinical settings: Type 2 Diabetes (T2D) follow-up (n = 141) and chronic liver disease (CLD) initial study (n = 138). Logistic regression analysis was performed to assess liver fibrosis diagnosis models based on FIB-4 and ELF biomarkers. The sequential algorithm retrieved the following accuracy parameters in predicting stages F3-4 in the biopsy-confirmed cohort: sensitivity (85%), specificity (73%), negative predictive value (79%) and positive predictive value (81%). In both T2D and CLD cohorts, a total of 28% of patients were classified as stages F3-4. Furthermore, of all F3-4 classified patients in the T2D cohort, 80% had a diagnosis of liver disease and 44% were referred to secondary care. Likewise, of all F3-4 classified patients in the CLD cohort, 71% had a diagnosis of liver disease and 44% were referred to secondary care. These results suggest the potential utility of this algorithm as a liver fibrosis stratifying tool in primary care, where updating referral protocols to detect high-risk F3-4 is needed. FIB-4 and ELF sequential measurement is an efficient strategy to prioritize patients with high risk of F3-4 in populations with metabolic risk factors.
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Affiliation(s)
- Pablo Gabriel-Medina
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain.
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain.
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain.
| | - Roser Ferrer-Costa
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain.
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain.
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Jesus Rivera-Esteban
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - J M Pericàs
- Liver Unit, Internal Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - D M Selva
- Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain
| | - Francisco Rodriguez-Frias
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Clinical Biochemistry Research Team, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
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Blanco-Grau A, Gabriel-Medina P, Rodriguez-Algarra F, Villena Y, Lopez-Martínez R, Augustín S, Pons M, Cruz LM, Rando-Segura A, Enfedaque B, Riveiro M, Casis E, Ferrer-Costa R, Buti M, Rodriguez-Frias F. Assessing Liver Fibrosis Using the FIB4 Index in the Community Setting. Diagnostics (Basel) 2021; 11:2236. [PMID: 34943471 PMCID: PMC8700445 DOI: 10.3390/diagnostics11122236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023] Open
Abstract
Liver disease is frequently asymptomatic, challenging early identification in the primary care setting. The fibrosis 4 (FIB4) index is a liver fibrosis biomarker that is a potential alternative to liver biopsy for diagnosing and managing liver disease. This study aimed to calculate the FIB4 index for screening individuals at high risk of liver disease at the community level. This was a retrospective real-world study analyzing blood and serum test results from a central laboratory. The primary outcome was the number of individuals within each risk category for hepatic fibrosis: high risk (FIB4 ≥ 3.25) and low risk (FIB4 < 1.3). The analysis included samples from 31,753 patients, of which 18,102 were aged 40 to 75 years. In these patients, the FIB4 index had been explicitly requested in 1852 (10.2%) cases and estimated ad hoc in the rest. Of the 263 (1.5%) cases with FIB4 ≥ 3.25, the FIB4 index was requested in 46 (17.5%), and 52 (19.8%) showed evidence of liver fibrosis in their medical records, while the rest did not report any data regarding liver fibrosis. FIB4 is a simple score that can play a role as a "red flag" for early identification of patients at high risk of advanced liver fibrosis and their referral to specialized care.
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Affiliation(s)
- Albert Blanco-Grau
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
- Clinical Biochemistry Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Pablo Gabriel-Medina
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
- Clinical Biochemistry Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | | | - Yolanda Villena
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
- Clinical Biochemistry Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Rosa Lopez-Martínez
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
| | - Salvador Augustín
- Liver Unit, Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (S.A.); (M.P.); (M.R.); (M.B.)
| | - Mònica Pons
- Liver Unit, Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (S.A.); (M.P.); (M.R.); (M.B.)
| | - Luz-Maria Cruz
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
| | - Ariadna Rando-Segura
- Clinical Microbiology (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Belen Enfedaque
- Community and Primary Care Management, Catalan Institute of Health, 08028 Barcelona, Spain;
| | - Mar Riveiro
- Liver Unit, Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (S.A.); (M.P.); (M.R.); (M.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Medicine and Science School, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Ernesto Casis
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
| | - Roser Ferrer-Costa
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (S.A.); (M.P.); (M.R.); (M.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Medicine and Science School, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Francisco Rodriguez-Frias
- Clinical Biochemistry (Clinical Laboratories), Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (A.B.-G.); (P.G.-M.); (Y.V.); (R.L.-M.); (L.-M.C.); (E.C.)
- Clinical Biochemistry Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Medicine and Science School, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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