Pankaj Rajvanshi, MD1, Srikrishna Gurumurthy, 2 1Swedish Medical Center, Redmond, WA; 2Nikola Tesla STEM High School, Redmond, WA
Introduction: FIB-4 has excellent sensitivity and negative predictive value (NPV) for significant (SF) and advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). Historically, FIB-4 has been studied in patients with NAFLD irrespective of the presence of type 2 diabetes mellitus (T2DM). With a variable performance of FIB-4 in patients with metabolic-associated fatty liver disease (MAFLD), we aimed to define the performance characteristics of FIB-4 in patients with NAFLD without T2DM.
Methods: We obtained data from the NIDDK NAFLD Adult database for 1266 patients. 1073 of 1266 patients with liver biopsy results were analyzed for this study. Patients were divided into two groups: NAFLD +/- T2DM and NAFLD without T2DM. We calculated a FIB-4 score on all patients. Cut-off values for SF (>F2) were FIB-4 >1.3, APRI > 0.7, BARD score > 2, and NFS of >-1.455. AF (>F3) was assessed with FIB-4 >2.67, APRI > 1, NFS > 0.675, and Cirrhosis (F4) with a FIB-4 >3.48 or APRI > 1.5.
Results: Patient characteristics of this cohort have been published. Among 1073 patients, 317 (29.5%) had T2DM, 298 (94%) of these patients had BMI >27, and 262 (82.6%) had a BMI >30. 756 (70.4%) patients did not have T2DM and 665 (88.0%) of these patients had BMI >27, 506 (66.9%) had a BMI >30. We found variable performance characteristics if FIB-4 in these two groups of patients.
A comparison of performance characteristics of FIB-4 in the two groups is shown in Table 1. As expected from the findings from existing literature, AUROC for FIB-4 in predicting SF is statistically superior in patients with NAFLD +/- T2DM compared to patients with NAFLD without T2DM. It has similar sensitivity (Sn) in both groups across all fibrosis stages, but it has statistically significant superior specificity (Sp) and positive predictive value (PPV) in patients without T2DM for prediction of significant fibrosis. Performance characteristics of FIB-4 are similar for >F3 and F4 in both groups.
Discussion: For prediction of advanced fibrosis (>F3, F4), the performance of FIB-4 in patients with NAFLD +/-T2DM when compared to patients without T2DM is similar. However, FIB-4 has superior Sp and PPV for SF in NAFLD without T2DM. We suggest that FIB-4 scores should be cautiously interpreted in patients with or without features of MAFLD.
Disclosures:
Pankaj Rajvanshi: AbbVie, Inc. – Speakers Bureau.
Srikrishna Gurumurthy indicated no relevant financial relationships.
Pankaj Rajvanshi, MD1, Srikrishna Gurumurthy, 2. P2438 - Evaluation of Performance Characteristics of FIB-4 in NAFLD With or Without Type 2 Diabetes, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
