Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways

Area of Science:

• Hepatology
• Non-invasive liver disease assessment
• Biomarker performance evaluation

Background:

• Primary care utilizes FIB-4 index for metabolic dysfunction-associated steatotic liver disease (MASLD) triage.
• FIB-4 accuracy may be influenced by patient characteristics like diabetes and obesity.

Purpose of the Study:

• Evaluate FIB-4 performance against elastography in MASLD.
• Compare FIB-4 with other non-invasive tests.
• Assess impact modification by BMI, diabetes, sex, ALT, and age.
• Calibrate 2D-SWE and VCTE thresholds.

Main Methods:

• Analysis of two cohorts (Calgary: 2D-SWE, N=8,126; Edmonton: VCTE, N=985) with paired serum scores and elastography.
• Used exceedance probabilities to align 2D-SWE with VCTE cut-offs.

Main Results:

• FIB-4 <1.30 was observed in 70-77% of patients.
• Individuals with diabetes or BMI ≥30 kg/m² showed higher probability of liver stiffness ≥8 kPa at FIB-4 of 1.30.
• BMI and diabetes significantly increased liver stiffness probability at a given FIB-4.

Conclusions:

• FIB-4 alone under-triages MASLD patients with diabetes and/or obesity.
• These patients warrant expedited elastography even with FIB-4 <1.30.
• Refined referral pathways incorporating patient characteristics are needed for improved MASLD risk stratification.