Dynamic FIB-4 Score Changes and HCC Risk in Patients with MASLD and Elevated Liver Enzymes: A Nationwide Cohort Study

Area of Science:

• Hepatology
• Oncology
• Non-invasive diagnostics

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) increases hepatocellular carcinoma (HCC) risk, even without cirrhosis.
• Current screening methods for HCC in MASLD patients are limited.
• Elevated liver enzymes in MASLD patients indicate a higher risk for HCC development.

Purpose of the Study:

• To investigate the association between serial changes in FIB-4 scores over three years and HCC risk in non-cirrhotic MASLD patients.
• To evaluate the predictive accuracy of serial FIB-4 score changes compared to single measurements for HCC development.
• To identify high-risk patient groups within the MASLD population requiring targeted HCC surveillance.

Main Methods:

• Utilized a nationwide cohort of 810,698 MASLD patients from the National Health Insurance Research Database (NHIRD).
• Analyzed FIB-4 score transitions (low, indeterminate, high risk) over a 3-year follow-up period.
• Employed competing risks modeling to estimate sub-distribution hazard ratios (SHRs) for HCC and mortality.

Main Results:

• Serial FIB-4 score changes demonstrated superior predictive accuracy for HCC risk compared to single measurements.
• Patients with persistently high FIB-4 scores (high-to-high) showed a 14-fold increased HCC risk (aSHR 13.91) versus those with consistently low scores (low-to-low).
• Worsening FIB-4 scores (e.g., low-to-high) progressively increased HCC risk, while improving scores (high-to-low) reduced it compared to the high-to-high group.

Conclusions:

• Serial FIB-4 score monitoring accurately identifies high-risk individuals for HCC in non-cirrhotic MASLD patients with elevated liver enzymes.
• Targeted HCC surveillance is warranted for patients exhibiting persistently high or worsening FIB-4 scores.
• This approach offers a more precise and scalable screening tool for HCC in the MASLD population.