Advanced liver fibrosis and the metabolic syndrome in a primary care setting.
Advanced liver fibrosis and the metabolic syndrome in a primary care setting.
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DOI：
10.1002/dmrr.3452
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Rockey DC
中科院分区：
文献类型：
--
作者：
Schreiner AD;Zhang J;Durkalski-Mauldin V;Livingston S;Marsden J;Bian J;Mauldin PD;Moran WP;Rockey DC
纤维化-4指数（FIB-4）和NAFLD纤维化评分（NFS）是在初级保健中评估晚期肝纤维化风险的无创和可访问的方法。我们评估了FIB-4和NFS评分在具有非酒精性脂肪性肝病（NAFLD）临床信号的初级保健患者中的分布。这项2007-2018年电子记录数据的回顾性队列研究包括至少有一种转氨酶异常且无已知（非NAFLD）肝病的成人。我们计算了患者水平的FIB-4和NFS评分，平均值超过晚期纤维化阈值的患者比例（不确定风险：FIB-4>1.3，NFS>-1.455;高风险：FIB-4>2.67，NFS>0.676），以及NAFLD ICD-9/10编码的患者比例。Logistic回归模型评估代谢综合征组分与FIB-4和NFS评分升高的相关性。该队列包括6，506例患者，每例患者的FIB-4和NFS评分中位数为6（IQR：3-13）。在这些患者中，81%至少有2种代谢综合征，29%的平均FIB-4和NFS评分不确定的纤维化风险，11%的平均FIB-4或NFS评分超过高晚期纤维化风险阈值。回归模型确定了低HDL、高血糖、黑人和男性与高风险FIB-4和NFS值的相关性。只有5%的患者有NAFLD的诊断。许多初级保健患者的FIB-4和NFS评分与晚期纤维化有关，但很少诊断为NAFLD。FIB-4和NFS评分升高可能为初级保健环境中肝脏疾病的进一步临床评估提供信号。
The Fibrosis-4 Index (FIB-4) and NAFLD fibrosis score (NFS) are non-invasive and accessible methods for assessing advanced liver fibrosis risk in primary care. We evaluated the distribution of FIB-4 and NFS scores in primary care patients with clinical signals for non-alcoholic fatty liver disease (NAFLD). This retrospective cohort study of electronic record data between 2007–2018 included adults with at least one abnormal aminotransferase and no known (non-NAFLD) liver disease. We calculated patient-level FIB-4 and NFS scores, the proportion of patients with mean values exceeding advanced fibrosis thresholds (indeterminate risk: FIB-4>1.3, NFS>−1.455; high-risk: FIB-4>2.67, NFS>0.676), and the proportion of patients with a NAFLD ICD-9/10 code. Logistic regression models evaluated the associations of metabolic syndrome components with elevated FIB-4 and NFS scores. The cohort included 6,506 patients with a median of 6 (IQR: 3–13) FIB-4 and NFS scores per patient. Of these patients, 81% had at least 2 components of metabolic syndrome, 29% had mean FIB-4 and NFS scores for indeterminate fibrosis risk, and 11% had either mean FIB-4 or NFS scores exceeding the high advanced fibrosis risk thresholds. Regression models identified associations of low HDL, hyperglycemia, Black race, and male gender with high-risk FIB-4 and NFS values. Only 5% of patients had existing diagnoses for NAFLD identified. Many primary care patients have FIB-4 and NFS scores concerning for advanced fibrosis, but rarely a diagnosis of NAFLD. Elevated FIB-4 and NFS scores may provide signals for further clinical evaluation of liver disease in primary care settings.
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影响因子：
13.5
作者：
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通讯作者：
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影响因子：
24.5
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