FIB-4 may identify patients at risk for MASLD despite normal aminotransferase levels
More than two-thirds of primary care patients who had high or indeterminate risk for metabolic dysfunction-associated steatotic liver disease (MASLD) based on the fibrosis-4 (FIB-4) score had aminotransferase levels within normal limits.
The noninvasive fibrosis-4 (FIB-4) score identified a substantial proportion of primary care patients at indeterminate or high risk for metabolic dysfunction-associated steatotic liver disease (MASLD) with fibrosis, most of whom had normal aminotransferase levels, a study found.
Researchers studied primary care patients at increased risk for MASLD with advanced fibrosis from 60 clinics and 300 clinicians affiliated with an academic medical center. The study cohort included 52,006 patients with a FIB-4 score in the year 2020 who were then stratified into low, indeterminate, and high likelihood of advanced fibrosis. Rates of subsequent testing were measured in those at indeterminate to high risk. Results were published July 26 by the Journal of General Internal Medicine.
Risk stratification with FIB-4 classified 77% of the cohort (n=40,026) as low risk, 17% (n=8,847) as indeterminate risk, and 6% (n=3,133) as high risk. Among indeterminate- or high-risk patients (n=11,980), 78.7% (n=9,433) had aminotransferase levels within normal limits, 0.95% (n=114) had elastography, and 8.2% (n=984) were referred for subspecialty evaluation.
The study authors observed that 23% of the studied patients had an indeterminate- or high-risk FIB-4 score and thus needed testing for advanced fibrosis. However, less than 1% underwent elastography and less than 10% underwent subspecialty evaluation, indicating that patients with MASLD at increased risk for advanced fibrosis are underdiagnosed, raising the risk for preventable liver-related-complications.
“With the rising prevalence of MASLD, we can expect further strain on limited healthcare resources and exacerbation of the already substantial economic burden,” the authors wrote. “These real-world data demonstrate that implementing screening pathways will likely optimize use of the limited available resources. This group also demonstrated the cost efficiency of such screening programs.”