The University of Southampton
University of Southampton Institutional Repository

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
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
1478-3223
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
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), 1303-1315. (doi:10.1111/liv.14416).

Record type: Article

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
Download (205kB)
Text
R1 Supplementary Tables - Accepted Manuscript
Download (135kB)
Text
R1 Tables - Accepted Manuscript
Download (103kB)

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
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×