Abstracts Division 2
36. Evaluation of the Fibrosis-4 score for the referral from primary care patients for non-alcoholic fatty liver disease
L. JM. Heyens1,2,3, D. Busschots1,4, J. Wellens5, M. Devos6, L. Present7, B. Schoenmakers8, K. De Munck9, E. Rubens9, K. Joris10, R. Remmen11, A. Bongaerts12, K. Breure12, F. Vanstraelen12, V. Vos12, T. Bijnens12, I. Houben13, S. Bertels13, L. Vanbrabant13, Y. Groenendaels13, L. Vernijns12, A. Robaeys13, L. v. Bokhoven14, M. Uitterhoeve-Prins15, T. De Somer16, G. Koek2,17, S. Francque18,19, C. Van Steenkiste16,18, J. Muris20, G. Robaeys1,3,21
1Hasselt University, Faculty of Life Sciences and Medicine, Hasselt, Belgium,
2Maastricht
University, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands,
3Ziekenhuis Oost-Limburg, Gastro-enterology, Genk, Belgium,
4Ziekenhuis Oost-Limburg, Gastro-enterology and Hepatology, Genk, Belgium,
5K.U.Leuven, Translational Research in Gastrointestinal Disorders, Leuven, Belgium,
6K.U.Leuven, Maatschappelijke Gezondheidszorg en Eerstelijnszorg, Leuven, Belgium,
7Huisartsenpraktijk Rendekens, Destelbergen, Belgium,
8K.U.Leuven, Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium,
9University of Antwerp, Faculty of Medicine, Antwerpen, Belgium,
10University of Antwerp, Faculty of Medicine, Wilrijk, Belgium,
11University of Antwerp, Maatschappelijke Gezondheidszorg en Eerstelijnszorg, Wilrijk, Belgium,
12Huisartsenbox, Genk, Belgium,
13Huisartsenpraktijk Termolen, Zonhoven, Belgium,
14Huisartsenpraktijk Dorine Verschure, Elsloo, The Netherlands,
15Dokters van Hier, Heer, The Netherlands,
16AZ Maria Middelares, Gastroenterology and Hepatology, Gent, Belgium,
17Mumc+, Gastro-enterology, Maastricht, Netherlands,
18University of Antwerp, Gastro-enterology and Hepatology, Antwerpen, Belgium,
19Antwerp University Hospital, Gastro-enterology and Hepatology, Edegem, Belgium,
20Maastricht University, Department of family medicine, Maastricht, The Netherlands,
21University Hospitals KU Leuven,Gastro-enterology, Leuven, Belgium
Background and Aims
Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. Moreover, fibrosis
stage is the most important predictor of prognosis. The Fibrosis-4 (FIB-4) is a
non-invasive score to predict fibrosis based on routine blood parameters. We
aimed to determine whether the FIB-4 is a valuable tool for identifying NAFLD
patients with fibrosis in primary care (PC) for referral to secondary or
tertiary care as most patients remain currently undetected.
Method
Patients were screened in seven Belgian (BE) and Dutch PC practices in a prospective pilot study. Using Vibration Controlled
Transient Elastography (VCTE) as a reference method, the fibrosis stage was
determined. Based on recent laboratory data, the FIB-4 was calculated. VCTE
measurements were graded according to the guidelines of the Belgian Association
for the Study of the Liver. To determine the risk of significant liver fibrosis
(≥F2) with the FIB-4, a cut-off value of 1.3 was used for patients younger
<65 years and 2.0 for patients older ≥65 years.
Results
554 patients were screened: 151 (46.1%) were male, mean age was 65±12 years, and BMI 28.8±4.9 kg/m². For 335 (60.5%)
patients, the FIB-4 and VCTE were available. Abnormal FIB-4 values were present
in 73 (21.8%) patients. Of these, 13 (17.8%) had a fibrosis grade F4, six
(8.2%) F2-F3 and 54 (74.0%) F0-F1. Normal FIB-4 values were present in 262
(82.8%) patients. Of these, 26 (9.9%) patients had F4, 19 (3.4%) had F2-3 and
217 (82.8%) had a fibrosis grade of F0-F1. Resulting in a positive predictive
value of 26.0%, a negative predictive value of 82.8%, and an overall accuracy
of 64.6% for screening of ≥F2 fibrosis in PC. Of the 64 ≥F2 patients diagnosed
according to VCTE, only 19 (29.6%) were correctly identified as having
fibrosis.
Conclusion
The use of the FIB-4 has only moderate accuracy to correctly identify patients with significant fibrosis for referral: missing
70% of cases and a high false-positive rate. We suggest evaluating other
strategies in PC for referral to secondary and tertiary care.
NUTRIM | School of Nutrition and Translational Research in Metabolism
NUTRIM aims to contribute to health maintenance and personalised medicine by unraveling lifestyle and disease-induced derangements in metabolism and by developing targeted nutritional, exercise and drug interventions. This is facilitated by a state of the art research infrastructure and close interaction between scientists, clinicians, master and PhD students.
www.maastrichtuniversity.nl/nutrim