P0965 - Fibrosis-4 as a Modality to Predict Emergency Department Outcome: A Large Cross-Sectional Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Roham Salman Roghani, MD

Eisenhower Health
Rancho Mirage, CA

Roham Salman Roghani, MD¹, Arsia Jamali, MD¹, Adewale B Ajumobi, MD²
¹Eisenhower Health, Rancho Mirage, CA; ²Eisenhower Health, University of California, Rancho Mirage, CA

Introduction: Fibrosis-4 (FIB-4) score is a reliable tool for assessing liver fibrosis risk. Although advanced fibrosis is linked to non-liver related poor outcomes, the role of FIB-4 in predicting outcomes in subclinical fibrosis remains unclear. The aim of this study is to evaluate the significance of the FIB-4 score in predicting clinical outcomes in patients who presented to the emergency department (ED).

Methods: A cross-sectional study was conducted on adults aged 18 years and older who visited the ED of a community teaching hospital from July 2017 to September 2022. Data on age, gender, ethnicity, body mass index (BMI), and medical comorbidities (including hypertension, diabetes mellitus, human immunodeficiency virus infection, cardiovascular disease, chronic liver disease, lung disease and kidney disease) were collected. ED visit outcomes including hospitalization, intensive care unit (ICU) stay during hospitalization, length of hospital stay, and disposition were assessed. Similarly, serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count at the time of ED were extracted. Participants were classified into three groups based on their FIB-4 scores: low (FIB-4 < 1.3), moderate (1.3 ≤ FIB-4 < 2.67), and high risk (FIB-4 ≥ 2.67) for liver fibrosis. Univariate analysis and multiple regression models were used to evaluate the independent association between risk of fibrosis and ED visit outcomes.

Results: A total of 233,996 individuals (mean age 61 ± 21[SD]; 53% female) were evaluated. Based on FIB-4 scores, 123,435 (52.7%) were classified as low risk, 76,984 (32.9%) as moderate risk, and 33,577 (14.4%) as high risk for fibrosis. Patients with moderate and high FIB-4 scores had higher hospital admission rates compared to those with low scores ((OR 1.51, 95% CI 1.48-1.55 and 2.35, 95% CI 2.29-2.42, respectively). Similarly, moderate and high FIB-4 scores were associated with increased ICU admission rates compared to the low-risk group (OR 1.27, 95% CI 1.20-1.35 and 2.02, 95% CI 1.89-2.15, respectively). Additionally, patients with high FIB-4 scores had longer hospital stays compared to moderate and low scores. The low-risk FIB-4 group had more favorable discharge outcomes with higher rates of home discharges.

Discussion: FIB-4 score is independently associated with worse ED visit outcomes, including higher hospital admission rates, longer hospital stays and ICU requirements. More studies are needed to validate these results.

	FIB-4 Categories			Total	P value
Emergency department outcome	Mild	Moderate	Severe	Total	P value
Hospital admission, n (%)	35,426 (28.7)	36.116 (46.9)	19,771 (58.9)	91,313 (39.0)	< 0.001
ICU admission, n (%)	3,181 (2.6)	3,260 (4.2)	2,307 (6.9)	8,748 (3.7)	< 0.001
Length of hospital stay, days	3.28 ± 3.79	3.25 ± 3.41	3.88 ± 3.85	3.40 ± 3.66	< 0.001
Disposition					< 0.001
Home, n (%)	114,874 (93.1)	64,023 (83.2)	24,555 (73.1)	203,452 (87)
Health care services, n (%)	4,941 (4.0)	6,533 (8.5)	4,089 (12.2)	15,563 (6.7)
Skilled nursing facility, n (%)	2,946 (2.4)	5,174 (6.7)	3,533 (10.5)	11,653 (5.0)
Hospice, n (%)	658 (0.5)	1,254 (1.6)	1,400 (4.2)	3,312 (1.4)

Table: Table 1. Study outcomes based on FIB-4 categories. P value less than 0.05 was considered significant.

Disclosures:

Roham Salman Roghani indicated no relevant financial relationships.

Arsia Jamali indicated no relevant financial relationships.

Adewale B Ajumobi indicated no relevant financial relationships.

Roham Salman Roghani, MD¹, Arsia Jamali, MD¹, Adewale B Ajumobi, MD². P0965 - Fibrosis-4 as a Modality to Predict Emergency Department Outcome: A Large Cross-Sectional Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.