Mazen Noureddin, MD, MHSc: MASLD-Related Fibrosis Risk Stratification with FIB-4, VCTE

Current guidelines from the American Gastroenterological Association (AGA) and American Association for the Study of Liver Diseases (AASLD) recommend sequential testing with FIB-4 followed by FibroScan in patients classified as having indeterminate risk by FIB-4 for advanced metabolic dysfunction-associated steatotic liver disease (MASLD)-related fibrosis screening. However, findings from a recent study are calling attention to potential misclassification with FIB-4 compared to transient elastography.

“I think they started with [recognizing] FIB-4 is cheap and can translate into easier utilization within primary care, and then they can go to FibroScan,” Mazen Noureddin, MD, MHSc, medical director of the Houston Research Institute and professor of medicine at Houston Methodist Academic Institute, said to HCPLive. “We said okay, let’s see how this algorithm works in the real world, meaning FIB-4 followed by transient elastography.”

Leveraging NHANES 2017-2020 data for patients at risk for clinically significant fibrosis, Noureddin and colleagues compared fibrosis risk assessed by FIB-4 versus liver stiffness measurement (LSM) on FibroScan and found notable discordance between the 2. Specifically, results showed 10% of patients classified as being at low risk of advanced fibrosis based on FIB-4 were not low risk based on their LSM score. Further analysis identified age, BMI, and CAP score as factors significantly associated with being misclassified as low-risk by FIB-4.

“We’re not trying to shoot down our guidelines and their algorithms. We had no screening before and now that we have a screening, it is good and it is going to save lives, but we also have to pay close attention,” Noureddin explained to HCPLive, emphasizing the importance of repeating FIB-4 in patients with a low-risk score but who have characteristics that put them at high risk of fibrosis. “If that one test was not translating into high risk, maybe repetitive tests of FIB-4 can show that high risk population and translate into transient elastography. I guess the message is screening is great, the algorithm is great, but pay attention and repetition matters.”

Noureddin concluded by saying that clinicians should not “just forget about it for 2 or 3 years” and should instead strive to make sense of the data and consider repeating FIB-4 more frequently.

References

^{Brooks, A. Study Describes Fibrosis Risk Misclassification with FIB-4 Compared to Transient Elastography. HCPLive. August 9, 2024. Accessed August 13, 2024. https://www.hcplive.com/view/study-describes-fibrosis-risk-misclassification-fib-4-transient-elastography}