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J Gastroenterol. 2018 Nov;53(11):1216-1224. doi: 10.1007/s00535-018-1474-y. Epub 2018 May 9.

The novel cutoff points for the FIB4 index categorized by age increase the diagnostic accuracy in NAFLD: a multi-center study.

Author information

1
Department of Gastroenterology, North Medical Center of Kyoto Prefectural University of Medicine, Yosanocho, Japan.
2
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
3
Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan. sumida19701106@yahoo.co.jp.
4
Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
5
Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
6
Department of Gastroenterology, JA Hiroshima Kouseiren General Hospital, Hiroshima, Japan.
7
Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan.
8
Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
9
Department of Internal Medicine, Saga Medical School, Saga University, Saga, Japan.
10
Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan.
11
Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
12
Department of Pathology, Nara City Hospital, Nara, Japan.
13
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
14
Hepatology Center, Saiseikai Suita Hospital, Suita, Japan.

Abstract

BACKGROUND:

The FIB4 index is clinically useful, but because its formula includes age, the appropriate cutoff point may differ by age group. Here, new FIB4 index cutoff points were validated using cohort data from 14 hepatology centers in Japan.

METHODS:

The FIB4 index was determined in biopsy-confirmed NAFLD patients (n = 1050) who were divided into four groups: ≤ 49, 50-59, 60-69, and ≥ 70 years. ROC analysis predicted advanced fibrosis in each age group; low and high cutoff points were defined by a sensitivity and specificity of 90%. The new and conventional cutoffs were compared for detecting advanced fibrosis.

RESULTS:

The modified low and high cutoff points were 1.05 and 1.21 in ≤ 49 years, 1.24 and 1.96 in 50-59 years, 1.88 and 3.24 in 60-69 years, and 1.95 and 4.56 in ≥ 70 years. In ≥ 60 years, the false-negative rate was increased using the modified high cutoff point, and the high cutoff point was better with the conventional cutoff point. The new proposed low and high cutoff points are 1.05 and 1.21 in ≤ 49 years, 1.24 and 1.96 in 50-59 years, 1.88 and 2.67 in 60-69 years, and 1.95 and 2.67 in ≥ 70 years; these cutoff points improved the accuracy of advanced fibrosis diagnosis.

CONCLUSIONS:

FIB4 index cutoff points for predicting advanced fibrosis in NAFLD increased with age. Cutoff points modified by age improved the diagnostic accuracy of estimations of advanced liver fibrosis using the FIB4 index.

KEYWORDS:

Advanced fibrosis; Diagnostic accuracy; FIB4 index; Non-alcoholic fatty liver disease; Non-invasive fibrosis marker

PMID:
29744597
DOI:
10.1007/s00535-018-1474-y
[Indexed for MEDLINE]

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