fib-4 is a potential tool for hepatocellular carcinoma risk stratification in ethnically diverse chronic hepatitis b patients when using specific cutoff values

Background: in a previous publication, a fib-4 cutoff value of ≥ 1.25, which had been determined in an asian population, did not allow reliable prediction of the development of hepatocellular carcinoma (hcc) in a patient collective with chronic hepatitis b (chb) of predominantly non-asian descent. objectives: here, we aimed to validate the modified fib-4 cutoff values as a means of stratifying the hcc risk in a non-asian cohort seen at an outpatient university hospital liver unit in germany. methods: we retrospectively analyzed 350 adult patients with chb infection. we recorded demographics, laboratory parameters, results from liver imaging, serological hepatitis b markers, antiviral treatment, and histology. we separated patients into two groups based on individual fib-4 levels. we, then, analyzed the patients’ hazard ratios for hcc and adjusted it for sex, age, antiviral medication, duration of chb infection, body mass index, alcohol consumption, and type 2 diabetes. an additional sub-analysis was performed by including only non-cirrhotic patients to determine the validity of the proposed cutoffs in that cohort. results: the median duration of follow-up was 8.9 years with a range of 1 - 21.3 years. our patients were 65% males. in comparison with patients that had a low fib-4 (< 0.3635), those with elevated fib-4 (≥0.3635) had an hcc incidence hazard ratio of 11.67 (95% confidence interval (ci): 2.73 - 49.96; p = 0.001) and an adjusted hazard ratio of 7.90 (95% ci: 1.58 - 39.39; p = 0.012). elevated fib-4 non-cirrhotic patients had a hazard ratio (hr) of 15.88 (95% ci: 2.04 - 123.20) for hcc incidence (p < 0.0001) and an adjusted hr of 11.99 (95% ci: 1.36 - 105.72) (p = 0.001). conclusions: a fib-4 value of < 0.3635 appears to be a clinical indicator for a low likelihood of hcc incidence in non-asian patients with chb with or without cirrhosis. further studies in patients of diverse descent are necessary to prove its utility as a clinical tool in this setting.