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Background: The relationship between fibrosis‐4 (FIB‐4) index and all‐cause mortality in critically ill patients with alcohol use disorder (AUD) is unclear. The present study aimed to investigate the predictive ability of FIB‐4 for all‐cause mortality in critically ill AUD patients and the association between them. Methods: A total of 2528 AUD patients were included using the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database. FIB‐4 was calculated for each patient using the existing formula. The patients were equally divided into four groups based on the quartiles of FIB‐4. Multivariate logistic regression and Cox proportional hazard model were used to evaluate the association of FIB‐4 with in‐hospital mortality, 28‐day mortality and 1‐year mortality. Kaplan–Meier curves were used to analyse the incidence of 28‐day mortality among four groups. Results: FIB‐4 was positively associated with 28‐day mortality of AUD patients with hazard ratio (HR) of 1.354 [95% confidence interval (CI) 1.192–1.538]. There were similar trends in the in‐hospital mortality [odds ratio (OR): 1.440, 95% CI (1.239–1.674)] and 1‐year mortality [HR: 1.325, 95% CI (1.178–1.490)]. Conclusion: Increased FIB‐4 is associated with greater in‐hospital mortality, 28‐day mortality and 1‐year mortality in critically ill AUD patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Non-invasive laboratory-based fibrosis indices have been proposed as a tool for population-based screening for advanced fibrosis. We aimed to examine the performance of fibrosis indices at the time of and prior to cirrhosis diagnosis. Methods: We included adult patients with cirrhosis diagnosis codes in a privately insured database (Optum) from 2010-2018 with 1:4 birth year-matched controls without cirrhosis diagnosis codes. We analyzed aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) up to 30 months prior to the entry of cirrhosis diagnosis codes. Cut-offs of

Abstract Background The relationship between fibrosis-4 (FIB-4) index and clinical outcomes in patients with acute kidney injury (AKI) is unclear. We aimed to investigate the association between FIB-4 index and all-cause mortality in critically ill patients with AKI. Methods We used data from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database (v1.4). The FIB-4 score was calculated using the existing formulas. logistic regression model, and Cox proportional hazards model were used to assessed the relationship between the FIB-4 index and in-hospital,28-day and 90-day mortality, respectively. Results A total of 3592 patients with AKI included in the data analysis. 395 (10.99%) patients died during hospitalization and 458 (12.74%) patients died in 28-day. During the 90-day follow-up, 893 (22.54%) patients were dead. An elevated FIB-4 value was significantly associated with increased in-hospital mortality when used as a continuous variable (odds ratio [OR] 1.183, 95% confidence interval [CI] 1.072–1.305, P = 0.002) and as a quartile variable (OR of Q2 to Q4 1.216–1.744, with Q1 as reference). FIB-4 was positively associated with 28-day mortality of AKI patients with hazard ratio (HR) of 1.097 (95% CI 1.008, 1.194) and 1.098 (95% 1.032, 1.167) for 90-day mortality, respectively. Conclusion This study demonstrated the FIB-4 index is associated with clinical outcomes in critically ill patients with acute kidney injury.

Background and Aim: MEFIB (the combination of magnetic resonance elastography [MRE] ≥ 3.3 kPa and fibrosis‐4 (FIB‐4) ≥ 1.6) is useful for detecting patients with significant fibrosis (fibrosis stage ≥ 2) having nonalcoholic fatty liver disease (NAFLD). However, age‐dependent thresholds of FIB‐4 have been proposed, and it remains unclear whether MEFIB could be applied with the same FIB‐4 threshold in a different cohort. Therefore, in this study, we examined the best threshold of FIB‐4 and validated the utility of MEFIB. Methods: This study included 105 biopsy‐proven NAFLD patients with contemporaneous MRE assessment. The primary outcome was a diagnostic accuracy for significant fibrosis. Results: The median (interquartile range) age was 65 (58–72) years, and significant fibrosis was 76.2% (80/105). FIB‐4 of 2.1 was defined as the best threshold for significant fibrosis in the cohort. The area under the receiver operating characteristics curves (AUROCs) of the combination of MRE and FIB‐4 (MRE ≥ 3.3 kPa + FIB‐4 ≥ 1.6: 0.80, MRE ≥ 3.3 kPa + FIB‐4 ≥ 2.1: 0.84) were higher than those of each index alone (MRE ≥ 3.3 kPa: 0.76, FIB‐4 ≥ 1.6: 0.72, and FIB‐4 ≥ 2.1: 0.77), but AUROCs of MRE ≥ 3.3 kPa + FIB‐4 ≥ 1.6 and MRE ≥ 3.3 kPa + FIB‐4 ≥ 2.1 were equivalent (P = 0.3). Conclusions: MEFIB is useful for detecting patients with significant fibrosis and could be utilized in a different cohort without changing the threshold of FIB‐4, and it may then be used as a two‐step screening strategy. [ABSTRACT FROM AUTHOR]

Introduction: Immunotherapy has become a new therapy for advanced hepatocellular carcinoma (HCC); however, its treatment results are considerably different. CD4+ T cells (CD4+) are the key to immunotherapy, but patients with HCC that have low CD4+ are rarely observed for clinical evidence. Hepatitis B virus-related HCC is often accompanied by cirrhosis and portal hypertension; therefore, CD4+ tend to be relatively low in number. TACE is the standard treatment for Barcelona Clinic Liver Cancer (BCLC)-B HCC, which may further reduce the number of CD4 + .Methods: This retrospective cohort study further reduced CD4+ by including patients with human immunodeficiency virus (HIV) to observe the relationship between CD4+ and Chronic hepatitis B virus (CHB) induced HCC. A total of 170 BCLC-B HCC patients (42 HIV+) were included. Univariate and multivariate analyses, and artificial neural networks (ANNs) were used to evaluate the independent risk factors for the two-year survival.Results: The statistical analysis of the two-year survival rate showed that the main factors influencing survival were liver function and immune indices, including CD4+, platelet, alanine aminotransferase, aspartate aminotransferase, aspartate aminotransferase-to-platelet ratio index, and fibrosis-4 (FIB-4) (P < 0.05). Compared with that in other indices, in logistic and ANN multivariate analysis, CD4 + -to-FIB-4 ratio (CD4+/FIB-4) had the highest importance with 0.716 C-statistic and 145.93 cut-off value. In terms of overall survival rate, HIV infection was not a risk factor (P = 0.589); however, CD4+/FIB-4 ≤ 145.93 significantly affected patient prognosis (P = 0.002).Conclusion: HIV infection does not affect the prognosis of BCLC-B HCC, but CD4+ have a significant predictive value. CD4+ played a vital role in HCC and this deserves the attention from physicians. Further, the CD4+/FIB-4 is a clinically valuable effective prognostic indicator for these patients. [ABSTRACT FROM AUTHOR]

Introduction and aims: Several non-invasive scoring systems have been developed and validated worldwide to predict the risk of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). However, information about the performance of these systems in Latin American populations is scarce. Our aim was to evaluate the performance of the Hepamet Fibrosis Score, Fibrosis-4 (FIB-4) and the NAFLD Fibrosis Score (NFS) in a mixed Latin American group of NAFLD patients. Methods: Clinical, laboratory and liver biopsy data collected from 379 biopsy-proven NAFLD patients from Latin American tertiary health centers were reviewed. Histological fibrosis stages were classified using the Kleiner score. Accuracy was determined, and new fibrosis score thresholds were calculated to better compare the performances of non-invasive tests and to explore their usefulness in excluding fibrosis. Results: The distribution of fibrosis stages among the sample population was as follows: F0 (45%), F1 (27%), F2 (8%), F3 (16%) and F4 (4%). Using modified thresholds, the areas under the ROC curves (AUROC) for Hepamet and FIB-4 (0.73 and 0.74, respectively) to detect significant fibrosis were higher than that of NFS (0.58). However, the AUROCs of the three scores were not significantly different in advanced fibrosis and cirrhosis. To exclude fibrosis, we calculated lower cutoffs than standard thresholds for Hepamet, FIB-4 and NFS with similar performances. Conclusion: Thresholds of non-invasive fibrosis scores (Hepamet, FIB-4 and NFS) can be modified to maximize diagnostic accuracy in Latin American patients with NAFLD.

Background: Hepatitis C still remain a serious problem in Indonesia lead to increasing prevalence , major morbidity and mortality. Liver biopsy is gold standar, invasive procedure for liver fibrosis staging for treatment monitoring and fibrosis regression. Fibrosis-4 (FIB-4) score has been proposed as a non-invasive, easy, inexpensive as alternative indirect marker for the assessment of liver fibrosis in chronic hepatitis C (CHC). Method: Analytical cross sectional study was conducted among 54 patients with CHC from 2012 -2017 in Saiful Anwar Hospital Malang. Subjects were examined for complete blood count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), anti hepatitis C virus (anti HCV), hepatitis C virus ribonucleic acid (HCV RNA), genotype, and performed liver biopsy. Statistical analysis was performed using Spearman test and statistical significant was assumed when p 0,05. Results: Fifty four (54) patients were fulfilled the selection criteria from total 67 patients. 29 (53%) males, and 25 (47%) were females. The characteristic were 33 (61%) genotype 1, 12 (22%) genotype 2, 5 (9%) genotype 3, and undetermined 3 (6%); with means of HCV RNA titer 2,57 x 106, AST 79 ± 44 IU/L, ALT 77 ± 48 IU/L platelet 160.000/mm3. Distribution of Metavir F1 10 (19%) , Metavir F2 31(57%), Metavir F3 6(11%), and Metavir F4 7 (13%). Median of FIB-4 score as Metavir F1 1,88;Metavir F2 3,24; Metavir F3 5,36; Metavir F4 4,36. There was positive correlation between FIB-4 score and Metavir score (r = 0.38; p = 0,01). Conclusion: This study indicate that there was significant correlation between FIB-4 score and Metavir score in CHC patients.

Background: The relationship between fibrosis-4 (FIB-4) index and clinical outcomes in patients with acute kidney injury (AKI) is unclear. We aimed to investigate the association between FIB-4 index and all-cause mortality in critically ill patients with AKI.Methods: We used data from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database (v1.4). The FIB-4 score was calculated using the existing formulas. logistic regression model, and Cox proportional hazards model were used to assessed the relationship between the FIB-4 index and in-hospital,28-day and 90-day mortality, respectively.Results: A total of 3592 patients with AKI included in the data analysis. 395 (10.99%) patients died during hospitalization and 458 (12.74%) patients died in 28-day. During the 90-day follow-up, 893 (22.54%) patients were dead. An elevated FIB-4 value was significantly associated with increased in-hospital mortality when used as a continuous variable (odds ratio [OR] 1.183, 95% confidence interval [CI] 1.072-1.305, P = 0.002) and as a quartile variable (OR of Q2 to Q4 1.216-1.744, with Q1 as reference). FIB-4 was positively associated with 28-day mortality of AKI patients with hazard ratio (HR) of 1.097 (95% CI 1.008, 1.194) and 1.098 (95% 1.032, 1.167) for 90-day mortality, respectively.Conclusion: This study demonstrated the FIB-4 index is associated with clinical outcomes in critically ill patients with acute kidney injury. [ABSTRACT FROM AUTHOR]

Introduction and aims: Several non-invasive scoring systems have been developed and validated worldwide to predict the risk of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). However, information about the performance of these systems in Latin American populations is scarce. Our aim was to evaluate the performance of the Hepamet Fibrosis Score, Fibrosis-4 (FIB-4) and the NAFLD Fibrosis Score (NFS) in a mixed Latin American group of NAFLD patients. Methods: Clinical, laboratory and liver biopsy data collected from 379 biopsy-proven NAFLD patients from Latin American tertiary health centers were reviewed. Histological fibrosis stages were classified using the Kleiner score. Accuracy was determined, and new fibrosis score thresholds were calculated to better compare the performances of non-invasive tests and to explore their usefulness in excluding fibrosis. Results: The distribution of fibrosis stages among the sample population was as follows: F0 (45%), F1 (27%), F2 (8%), F3 (16%) and F4 (4%). Using modified thresholds, the areas under the ROC curves (AUROC) for Hepamet and FIB-4 (0.73 and 0.74, respectively) to detect significant fibrosis were higher than that of NFS (0.58). However, the AUROCs of the three scores were not significantly different in advanced fibrosis and cirrhosis. To exclude fibrosis, we calculated lower cutoffs than standard thresholds for Hepamet, FIB-4 and NFS with similar performances. Conclusion: Thresholds of non-invasive fibrosis scores (Hepamet, FIB-4 and NFS) can be modified to maximize diagnostic accuracy in Latin American patients with NAFLD. [ABSTRACT FROM AUTHOR]

Background: Short-time usage of direct-acting antiviral agents (DAA) limited knowledge regarding histological outcomes and predictive values of noninvasive measurements in patients with hepatitis C virus (HCV) after sustained virologic response (SVR) with DAA.Aims: This study aimed to indicate histological changes and assess predictive value of noninvasive measurements for fibrosis in these patients.Methods: HCV patients who achieved SVR by DAA were identified. Pre- and post-SVR clinical and histological data were collected.Results: Of patients, 83% (33/40), 38% (15/40) and 83% (33/40) achieved inflammation improvement, fibrosis regression and histological improvement, respectively. Liver stiffness measurements (LSM), APRI, and FIB-4 could predict post-SVR fibrosis well without significant differences. Areas under receiver operating characteristic curves of LSM, APRI, and FIB-4 were 0.78, 0.81, and 0.87 for post-SVR advanced fibrosis (≥ F4) and 0.86, 0.86, and 0.85 for post-SVR cirrhosis (≥ F5), respectively. Pre-SVR LSM, APRI, and FIB-4 values were significantly lower in patients with fibrosis regression (P = 0.003-0.012), while FIB-4 was significantly lower in patients with histological improvement (P = 0.012-0.033). Patients with higher pre-SVR Ishak scores tended to have bigger decline in APRI (P = 0.025) and FIB-4 (P = 0.024) after SVR.Conclusions: DAA could improve liver inflammation and fibrosis of HCV patients in a short time after SVR. LSM, APRI, and FIB-4 predict fibrosis well even after SVR by DAA. Most of the cutoff values for advanced fibrosis (≥ F4) and cirrhosis (≥ F5) of these noninvasive measurements decreased significantly after SVR, maybe because of the inflammation improvement. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C still remain a serious problem in Indonesia lead to increasing prevalence, major morbidity and mortality. Liver biopsy is gold standar, invasive procedure for liver fibrosis staging for treatment monitoring and fibrosis regression. Fibrosis-4 (FIB-4) score has been proposed as a non-invasive, easy, inexpensive as alternative indirect marker for the assessment of liver fibrosis in chronic hepatitis C (CHC). Method: Analytical cross sectional study was conducted among 54 patients with CHC from 2012-2017 in Saiful Anwar Hospital Malang. Subjects were examined for complete blood count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), anti hepatitis C virus (anti HCV), hepatitis C virus ribonucleic acid (HCV RNA), genotype, and performed liver biopsy. Statistical analysis was performed using Spearman test and statistical significant was assumed when p < 0,05. Results: Fifty four (54) patients were fulfilled the selection criteria from total 67 patients. 29 (53%) males, and 25 (47%) were females. The characteristic were 33 (61%) genotype 1, 12 (22%) genotype 2, 5 (9%) genotype 3, and undetermined 3 (6%); with means of HCV RNA titer 2,57 x 106, AST 79 ± 44IU/L, ALT 77 ± 48IU/L platelet 160.000/mm3. Distribution of Metavir F1 10 (19%), Metavir F2 31(57%), Metavir F3 6(11%), and Metavir F4 7 (13%). Median of FIB-4 score as Metavir F1 1,88;Metavir F2 3,24; Metavir F3 5,36; Metavir F4 4,36. There was positive correlation between FIB-4 score and Metavir score (r = 0.38; p = 0,01). Conclusion: This study indicate that there was significant correlation between FIB-4 score and Metavir score in CHC patients. [ABSTRACT FROM AUTHOR]

Noninvasive fibrosis indices can help stratify the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogue (NA) therapy. We investigated the predictive performance of on-treatment changes in FIB-4 (△FIB-4) and 1-year FIB-4 values (FIB-4 12M) for HCC risk in patients with CHB receiving entecavir therapy. We included 1325 NA-naïve patients with CHB treated with entecavir, retrospectively, from January 2007 to August 2012. A combination of △FIB-4 and FIB-4 12M was used to stratify the cumulative risk of HCC into three subgroups each in the noncirrhotic and cirrhotic subgroups with p < 0.0001 by using the log-rank test (noncirrhotic: the highest risk (n = 88): FIB-4 12M ≥ 1.58/△FIB-4 ≥ 0 (hazard ratio (HR): 40.35; 95% confidence interval (CI): 5.107–318.7; p <0.0001) and cirrhotic: the highest risk (n = 89): FIB-4 12M ≥2.88/△FIB-4 ≥0 (HR: 9.576; 95% CI: 5.033–18.22; p < 0.0001)). Patients with noncirrhotic CHB treated with entecavir who had a FIB-4 12M < 1.58 or FIB-4 12M ≥ 1.58/△FIB-4 < 0 exhibited the lowest 5-year HCC risk (0.6%). A combination of on-treatment changes in FIB-4 and 1-year FIB-4 values may help identify patients with CHB receiving entecavir therapy with the lowest risk of HCC. [ABSTRACT FROM AUTHOR]