| アブストラクト | BACKGROUND: The Fibrosis-4 Index (FIB-4) is used as a non-invasive tool for the presence of advanced liver fibrosis in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes. However, evidence for an association between FIB-4 and risk of mortality and/or liver-related clinical outcomes is limited. The aim of this study was to investigate the association between FIB-4 and subsequent liver events, cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes examined in routine general practice. METHODS: This was a longitudinal cohort study in which eligible adults had obesity and/or type 2 diabetes and >/=1 FIB-4 score calculable from UK Clinical Practice Research Datalink GOLD after 1 January 2001. No alcohol-related disorders and/or chronic liver diseases (except non-alcoholic fatty liver disease) and/or no prescriptions of drugs inducing liver disease were permitted. Individuals were followed until time of first event, 10 years, or 1 January 2020. Analyses were conducted using Aalen-Johansen cumulative incidence functions and Cox proportional hazards models. FINDINGS: Among 44,481 included individuals (mean age 58.8 years; 54% female), there were 979 liver, 6002 cardiovascular, and 8971 mortality events during the 10 years of follow-up. At 10 years, the cumulative incidence of liver events in the high (>2.67), indeterminate (1.30-2.67), and low (<1.30) baseline FIB-4 risk groups were 15%, 3%, and 1%, respectively. Age- and sex-adjusted hazard ratios (HRs) for liver events were elevated in high (16.46; 95% confidence interval [CI] 13.65-19.85) and indeterminate (2.45; 95% CI 2.07-2.90) versus low FIB-4 risk groups. Similar results were found for cardiovascular events and all-cause mortality. Among 20,433 individuals with >/=2 FIB-4 measurements, increase/decrease in FIB-4 12 months after baseline was directly associated with risk of liver events: compared with individuals with low baseline FIB-4 and no change in FIB-4 (reference), the adjusted HR (95% CI) for those with high baseline FIB-4 was 24.27 (16.98-34.68) with a one-unit FIB-4 increase, and 10.90 (7.90-15.05) with a one-unit decrease. INTERPRETATION: In addition to its value as a diagnostic tool, FIB-4 has clinical utility as a prognostic biomarker. Sequential measurement provides a pragmatic, tractable monitoring biomarker that refines risk assessment for liver events, cardiovascular events, and mortality. FUNDING: Novo Nordisk A/S. |
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| ジャーナル名 | The Lancet regional health. Europe |
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| 投稿日 | 2024/1/8 |
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| 投稿者 | Anstee, Quentin M; Berentzen, Tina L; Nitze, Louise M; Jara, Maximilian; Jensen, Anders B; Kjaer, Mette S; Mangla, Kamal K; Tarp, Jens M; Khunti, Kamlesh |
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| 組織名 | Translational & Clinical Research Institute, Faculty of Medical Sciences,;Newcastle University, Newcastle upon Tyne, UK.;Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS;Trust, Newcastle upon Tyne, UK.;Novo Nordisk A/S, Soborg, Denmark.;Diabetes Research Centre, University of Leicester, Leicester General Hospital,;Leicester, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38188279/ |
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