Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease
Background and aims Historical paired liver biopsy studies are likely to underestimate current progression of disease in patients with chronic hepatitis C virus (HCV) infection. We aimed to assess liver disease progression according to the non-invasive Fibrosis-4 (FIB-4) index in patients with chron...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/10/1/e001209.full |
| _version_ | 1827184168842297344 |
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| author | Nicole S Erler Robert J de Knegt Jordan J Feld Bettina E Hansen Harry L A Janssen Adriaan J van der Meer Christoph Welsch Stefan Zeuzem Amy Puenpatom Thomas Vanwolleghem Robert A de Man Lisette A P Krassenburg Raoel Maan Stijn van Hees Orlando Cerrhoci Johannes Vermehren |
| author_facet | Nicole S Erler Robert J de Knegt Jordan J Feld Bettina E Hansen Harry L A Janssen Adriaan J van der Meer Christoph Welsch Stefan Zeuzem Amy Puenpatom Thomas Vanwolleghem Robert A de Man Lisette A P Krassenburg Raoel Maan Stijn van Hees Orlando Cerrhoci Johannes Vermehren |
| author_sort | Nicole S Erler |
| collection | DOAJ |
| description | Background and aims Historical paired liver biopsy studies are likely to underestimate current progression of disease in patients with chronic hepatitis C virus (HCV) infection. We aimed to assess liver disease progression according to the non-invasive Fibrosis-4 (FIB-4) index in patients with chronic HCV and early disease.Methods and results Patients diagnosed with chronic HCV and FIB-4 <3.25 from four international liver clinics were included in a retrospective cohort study. Follow-up ended at start of antiviral therapy resulting in sustained virological response, at time of liver transplantation or death. Primary outcome of advanced liver disease was defined as FIB-4 >3.25 during follow-up. Survival analyses were used to assess time to FIB-4 >3.25.In total, 4286 patients were followed for a median of 5.0 (IQR 1.7–9.4) years, during which 41 071 FIB-4 measurements were collected. At baseline, median age was 47 (IQR 39–55) years, 2529 (59.0%) were male, and 2787 (65.0%) patients had a FIB-4 <1.45. Advanced liver disease developed in 821 patients. Overall, 10-year cumulative incidence of advanced disease was 32.1% (95% CI 29.9% to 34.3%). Patients who developed advanced disease showed an exponential FIB-4 increase. Among patients with a presumed date of HCV infection, cumulative incidence of advanced disease increased 7.7-fold from 20 to 40 years as opposed to the first 20 years after HCV infection.Conclusions The rate of advanced liver disease is high among chronic HCV-infected patients with early disease at time of diagnosis, among whom liver disease progression accelerated over time. These results emphasise the need to overcome any limitations with respect to diagnosing and treating all patients with chronic HCV across the globe. |
| first_indexed | 2024-03-08T18:21:24Z |
| format | Article |
| id | doaj.art-20684bd7459a42a999c55f58c9c6cca6 |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2025-03-21T06:30:13Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-20684bd7459a42a999c55f58c9c6cca62024-07-20T20:25:10ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742023-12-0110110.1136/bmjgast-2023-001209Progression of the FIB-4 index among patients with chronic HCV infection and early liver diseaseNicole S Erler0Robert J de Knegt1Jordan J Feld2Bettina E Hansen3Harry L A Janssen4Adriaan J van der Meer5Christoph Welsch6Stefan Zeuzem7Amy Puenpatom8Thomas Vanwolleghem9Robert A de Man10Lisette A P Krassenburg11Raoel Maan12Stijn van Hees13Orlando Cerrhoci14Johannes Vermehren15Department of Epidemiology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsFrancis Family Liver Clinic, Toronto Centre for Liver Disease, Toronto, Ontario, CanadaDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Internal Medicine 1, Frankfurt Hospital Consortium, Frankfurt am Main, GermanyDepartment of Internal Medicine 1, Frankfurt Hospital Consortium, Frankfurt am Main, GermanyMerck & Co, Kenilworth, New Jersey, USADepartment of Gastroenterology and Hepatology, University Hospital Antwerp, Edegem, BelgiumDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Gastroenterology and Hepatology, University Hospital Antwerp, Edegem, BelgiumFrancis Family Liver Clinic, Toronto Centre for Liver Disease, Toronto, Ontario, CanadaDepartment of Internal Medicine 1, Frankfurt Hospital Consortium, Frankfurt am Main, GermanyBackground and aims Historical paired liver biopsy studies are likely to underestimate current progression of disease in patients with chronic hepatitis C virus (HCV) infection. We aimed to assess liver disease progression according to the non-invasive Fibrosis-4 (FIB-4) index in patients with chronic HCV and early disease.Methods and results Patients diagnosed with chronic HCV and FIB-4 <3.25 from four international liver clinics were included in a retrospective cohort study. Follow-up ended at start of antiviral therapy resulting in sustained virological response, at time of liver transplantation or death. Primary outcome of advanced liver disease was defined as FIB-4 >3.25 during follow-up. Survival analyses were used to assess time to FIB-4 >3.25.In total, 4286 patients were followed for a median of 5.0 (IQR 1.7–9.4) years, during which 41 071 FIB-4 measurements were collected. At baseline, median age was 47 (IQR 39–55) years, 2529 (59.0%) were male, and 2787 (65.0%) patients had a FIB-4 <1.45. Advanced liver disease developed in 821 patients. Overall, 10-year cumulative incidence of advanced disease was 32.1% (95% CI 29.9% to 34.3%). Patients who developed advanced disease showed an exponential FIB-4 increase. Among patients with a presumed date of HCV infection, cumulative incidence of advanced disease increased 7.7-fold from 20 to 40 years as opposed to the first 20 years after HCV infection.Conclusions The rate of advanced liver disease is high among chronic HCV-infected patients with early disease at time of diagnosis, among whom liver disease progression accelerated over time. These results emphasise the need to overcome any limitations with respect to diagnosing and treating all patients with chronic HCV across the globe.https://bmjopengastro.bmj.com/content/10/1/e001209.full |
| spellingShingle | Nicole S Erler Robert J de Knegt Jordan J Feld Bettina E Hansen Harry L A Janssen Adriaan J van der Meer Christoph Welsch Stefan Zeuzem Amy Puenpatom Thomas Vanwolleghem Robert A de Man Lisette A P Krassenburg Raoel Maan Stijn van Hees Orlando Cerrhoci Johannes Vermehren Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease BMJ Open Gastroenterology |
| title | Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease |
| title_full | Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease |
| title_fullStr | Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease |
| title_full_unstemmed | Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease |
| title_short | Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease |
| title_sort | progression of the fib 4 index among patients with chronic hcv infection and early liver disease |
| url | https://bmjopengastro.bmj.com/content/10/1/e001209.full |
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