Dynamic changes in the liver fibrosis marker FIB-4 as a predictor of adverse cardiovascular events in patients with high and very high cardiovascular risk

The aim of the study was to assess the prognostic significance of dynamic changes in the surrogate noninvasive liver fibrosis marker FIB-4 in relation to the development of adverse cardiovascular events in patients with high and very high cardiovascular risk (CVR). Materials and Methods. Men and women aged 40-67 years with high and very high CVR were included in the study. Fibrosis-4 index (FIB-4) was used as a noninvasive marker of liver fibrosis. The combined end point was death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization. Results. 105 patients with high and very high CVR were included in the study. The duration of the follow-up period was 34.6 (15.0; 52.3) months. Events constituting the combined end point occurred in 26 (24.7%) patients. During the follow-up period, FIB-4 index values of <1.45 (0.90 (0.68; 1.23) at study inclusion changed to ≥1.45 (1.66 (1.61; 1.90) in 13 (12.4%) patients. Over the follow-up period, the median FIB-4 change was -23.0% (-1.81; 11.5) and by the end of the follow-up period, the median FIB-4 values were 1.17 (0.97; 1.47). According to Kaplan-Meier analysis, the cumulative risk of events constituting the combined end point was found to be significantly higher in patients with an increase in FIB-4. By Cox single-factor regression analysis, an increase in FIB-4 (from values <1.45 to ≥1.45) was associated with a 4.42-fold increase in the relative risk (RR) of events constituting the combined end point (95% CI 1.33-14.7; p=0.015). Conclusion. In patients with high and very high CVR over 40 years of age, an increase in FIB-4 liver fibrosis index from values <1.45 to ≥1.45 during 2.8 years of follow-up was associated with a 4.42-fold increase in the RR of adverse cardiovascular events (95% CI 1.33-14.7; p=0.015).

FIB-4, nonalcoholic fatty liver disease, cardiovascular risk, noninvasive laboratory markers of liver fibrosis

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