Non-invasive liver fibrosis scores are strongly associated with liver cancer mortality in general population without liver disease
Non-invasive liver fibrosis scores are strongly associated with liver cancer mortality in general population without liver disease
Background & Aims: In a general population without known liver disease, we tested whether: (a) increased liver fibrosis scores (FIB-4 and APRI) are associated with liver cancer mortality and (b) the probability that a person with a higher score died of liver cancer. Methods: In a retrospective occupational cohort who underwent annual/biennial health examinations (between 2002 and 2015), subjects were excluded with known chronic liver disease. Based on their baseline FIB-4 and APRI scores, subjects were categorised in low-/intermediate-/high-risk groups for advanced liver fibrosis. Using Cox proportional hazards regression analyses adjusted hazard ratios (aHR) were estimated for liver cancer mortality, with the low-risk FIB-4/APRI group as the reference. Harrell's C statistics were also calculated. Results: In 200 479 participants, mean (SD) age was 36.4 (7.7) years. Median follow-up was 4.1 years (IQR 2.10-8.03) with 80 liver cancer deaths. High baseline FIB-4 or APRI scores occurred in 0.25% and 0.09% of subjects respectively. A high FIB-4 or APRI score was associated with a markedly increased risk of liver cancer mortality (aHRs 629.10 [95% CI 228.74-1730.20] and 80.42 [95% CI 34.37-188.18]) respectively. C statistics were FIB-4 = 0.841 (95% CI 0.735-0.946) and APRI = 0.933 (95% CI 0.864-0.999). Conclusions: In a general population without known liver disease, high FIB-4 or high APRI (in keeping with a high probability of advanced fibrosis) occurred in 0.25% (FIB-4) and 0.09% (APRI) of subjects. Both scores were associated with a markedly increased risk of liver cancer mortality and FIB-4 and APRI models both strongly predicted liver cancer mortality.
liver cancer, liver fibrosis scores, mortality
1303-1315
Sung, Ki-Chul
7da42bc5-d98e-407d-a39a-1bd5729fec8a
Johnston, Michael P.
50f7f267-8e9e-497c-84dd-15f905b9419d
Lee, Mi Yeon
b834bd17-adb1-4347-8030-77904566fb6e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
1 June 2020
Sung, Ki-Chul
7da42bc5-d98e-407d-a39a-1bd5729fec8a
Johnston, Michael P.
50f7f267-8e9e-497c-84dd-15f905b9419d
Lee, Mi Yeon
b834bd17-adb1-4347-8030-77904566fb6e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Sung, Ki-Chul, Johnston, Michael P., Lee, Mi Yeon and Byrne, Christopher
(2020)
Non-invasive liver fibrosis scores are strongly associated with liver cancer mortality in general population without liver disease.
Liver International, 40 (6), .
(doi:10.1111/liv.14416).
Abstract
Background & Aims: In a general population without known liver disease, we tested whether: (a) increased liver fibrosis scores (FIB-4 and APRI) are associated with liver cancer mortality and (b) the probability that a person with a higher score died of liver cancer. Methods: In a retrospective occupational cohort who underwent annual/biennial health examinations (between 2002 and 2015), subjects were excluded with known chronic liver disease. Based on their baseline FIB-4 and APRI scores, subjects were categorised in low-/intermediate-/high-risk groups for advanced liver fibrosis. Using Cox proportional hazards regression analyses adjusted hazard ratios (aHR) were estimated for liver cancer mortality, with the low-risk FIB-4/APRI group as the reference. Harrell's C statistics were also calculated. Results: In 200 479 participants, mean (SD) age was 36.4 (7.7) years. Median follow-up was 4.1 years (IQR 2.10-8.03) with 80 liver cancer deaths. High baseline FIB-4 or APRI scores occurred in 0.25% and 0.09% of subjects respectively. A high FIB-4 or APRI score was associated with a markedly increased risk of liver cancer mortality (aHRs 629.10 [95% CI 228.74-1730.20] and 80.42 [95% CI 34.37-188.18]) respectively. C statistics were FIB-4 = 0.841 (95% CI 0.735-0.946) and APRI = 0.933 (95% CI 0.864-0.999). Conclusions: In a general population without known liver disease, high FIB-4 or high APRI (in keeping with a high probability of advanced fibrosis) occurred in 0.25% (FIB-4) and 0.09% (APRI) of subjects. Both scores were associated with a markedly increased risk of liver cancer mortality and FIB-4 and APRI models both strongly predicted liver cancer mortality.
Text
R1 Manuscript Non-invasive liver fibrosis scores
- Accepted Manuscript
Text
R1 Supplementary Tables
- Accepted Manuscript
Text
R1 Tables
- Accepted Manuscript
More information
Accepted/In Press date: 19 February 2020
e-pub ahead of print date: 23 February 2020
Published date: 1 June 2020
Additional Information:
Funding Information:
CDB is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004), UK. MPJ is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and Southampton Academy of Research.
Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Keywords:
liver cancer, liver fibrosis scores, mortality
Identifiers
Local EPrints ID: 438229
URI: http://eprints.soton.ac.uk/id/eprint/438229
ISSN: 1478-3223
PURE UUID: 519d072b-e92c-4322-bb1e-d88e5035e279
Catalogue record
Date deposited: 04 Mar 2020 17:31
Last modified: 17 Mar 2024 05:21
Export record
Altmetrics
Contributors
Author:
Ki-Chul Sung
Author:
Michael P. Johnston
Author:
Mi Yeon Lee
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
