In the American Gastroenterological Association/American Association for the Study of Liver Diseases (AGA/AASLD) Clinical Care Pathway, Fibrosis-4 index (FIB-4) is used to stratify patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) as low-, indeterminate-, or high-risk for developing advanced liver fibrosis. We assessed the performance of FIB-4 in a general population. Using the 2017 to 2020 National Health and Nutrition Examination Surveys dataset, we selected subjects ≥18 years who had FibroScan data. We followed AGA/AASLD guidelines to identify subjects with characteristics that place them at risk for MASLD-associated liver fibrosis. Other causes of liver disease were excluded. Our final cohort had 3741 subjects. We then categorized these subjects based on recommended FIB-4 cutoffs. FibroScan liver stiffness measurement (LSM) served as the outcome measurement. Among the 2776 subjects (74.2%) classified as low risk by FIB-4, 277 subjects (10%) were not classified at low risk by LSM, and 75 subjects (2.7%) were classified as high risk by LSM. Among the 86 subjects classified as high risk by FIB-4, 68 subjects (79.1%) were not at high risk by LSM, and 54 subjects (62.8%) were at low risk by LSM. Subjects misclassified by FIB-4 as low risk were older; had a higher body mass index, waist circumference, glycohemoglobin A1c level, alanine transaminase, aspartate transaminase, diastolic blood pressure, controlled attenuation parameter score, white blood cell count, alkaline phosphatase, and fasting glucose level; but had lower high-density lipoprotein, and albumin level (all < .05). Misclassified subjects were also more likely to have prediabetes/diabetes. Using FIB-4 in the AGA/AASLD guidelines to risk-stratify subjects at risk for MASLD-associated fibrosis results in many subjects being misclassified into the low- and high-risk categories. Therefore, it may be worthwhile considering caution in interpretation and/or alternative strategies.

中文翻译：

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FIB-4 与瞬时弹性成像之间的不一致程度：当前指南在一般人群队列中的应用

在美国胃肠病学协会/美国肝病研究协会 (AGA/AASLD) 临床护理途径中，纤维化 4 指数 (FIB-4) 用于对有代谢功能障碍相关脂肪肝病 (MASLD) 风险的患者进行分层发展为晚期肝纤维化的低风险、不确定风险或高风险。我们评估了 FIB-4 在一般人群中的表现。使用 2017 年至 2020 年国家健康和营养检查调查数据集，我们选择了 18 岁以上且拥有 FibroScan 数据的受试者。我们遵循 AGA/AASLD 指南来识别具有 MASLD 相关肝纤维化风险特征的受试者。排除了肝病的其他原因。我们的最终队列有 3741 名受试者。然后，我们根据推荐的 FIB-4 截止值对这些主题进行分类。 FibroScan 肝脏硬度测量 (LSM) 作为结果测量。在 FIB-4 分类为低风险的 2776 名受试者（74.2%）中，LSM 未将 277 名受试者（10%）分类为低风险，LSM 分类为 75 名受试者（2.7%）高风险。在 FIB-4 分类为高风险的 86 名受试者中，68 名受试者（79.1%）根据 LSM 不属于高风险，54 名受试者（62.8%）根据 LSM 属于低风险。被 FIB-4 错误分类为低风险的受试者年龄较大；具有较高的体重指数、腰围、糖化血红蛋白 A1c 水平、丙氨酸转氨酶、天冬氨酸转氨酶、舒张压、受控衰减参数评分、白细胞计数、碱性磷酸酶和空腹血糖水平；但高密度脂蛋白和白蛋白水平较低（均 < .05）。错误分类的受试者也更有可能患有糖尿病前期/糖尿病。在 AGA/AASLD 指南中使用 FIB-4 对具有 MASLD 相关纤维化风险的受试者进行风险分层会导致许多受试者被错误分类为低风险和高风险类别。因此，谨慎解释和/或替代策略可能是值得的。