Non-invasive fibrosis markers are associated with mortality risk in both general populations and non-alcoholic fatty liver disease patients

Xianhua Mao; Zhenqiu Liu; Oumin Shi; Kangkang Yu; Yanfeng Jiang; Li Jin; Tiejun Zhang; Xingdong Chen

doi:10.1111/hepr.13570

Non-invasive fibrosis markers are associated with mortality risk in both general populations and non-alcoholic fatty liver disease patients

Hepatol Res. 2021 Jan;51(1):90-101. doi: 10.1111/hepr.13570. Epub 2020 Oct 8.

Authors

Xianhua Mao^{1

2}, Zhenqiu Liu^{1

2}, Oumin Shi³, Kangkang Yu⁴, Yanfeng Jiang^{1

2}, Li Jin^{1

2}, Tiejun Zhang^{2

5

6}, Xingdong Chen^{1

2}

Affiliations

¹ State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.
² Fudan University Taizhou Institute of Health Sciences, Taizhou, China.
³ Health Science Center, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
⁴ Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
⁵ Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.
⁶ Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.

PMID: 32946623
DOI: 10.1111/hepr.13570

Abstract

Aim: We assessed the correlations between non-invasive fibrosis scores and mortality in both the general population and non-alcoholic fatty liver disease (NAFLD) patients.

Methods: We used data from the US National Health and Nutrition Examination Survey 1988-2014. The NAFLD fibrosis score (NFS), Fibrosis-4 index (FIB-4) score, aspartate aminotransferase to platelet ratio index (APRI) score, and Forns index score were calculated at baseline. The associations of these scores with the risk of mortality were determined using additive Cox proportional hazard models. The area under the receiver operating characteristic curve (AUROC) was used to study the predictive capacity of each scoring system.

Results: A total of 44 508 participants were included; among them, 9721 deaths occurred during a mean follow-up of 12.5 years. A "J"-shaped correlation pattern was observed for both the FIB-4 and APRI scores. A "U"-shaped correlation pattern was observed for both the Forns index and NFS. Similar correlation patterns were observed in 1955 NAFLD patients. For overall mortality, the AUROC values of the selected fibrosis scores were comparable between general population and NAFLD patients. The superior predictive capacity was found for FIB-4, with AUROC of 75.03% (95% confidence interval, 70.91% to 79.82%) in general population and 75.32% (95% confidence interval, 69.43% to 80.11%) in NAFLD patients, respectively.

Conclusions: Non-linear associations were shown between the fibrosis scoring systems and mortality risk. These scores could serve as indicators for mortality in people with or without NAFLD.

Keywords: APRI; FIB-4; Forns; NFS; fibrosis score; mortality; prediction.

Abstract

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