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FIB-4 as a screening and disease monitoring method in pre-fibrotic stages of metabolic dysfunction-associated fatty liver disease (MASLD)
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FIB-4 as a screening and disease monitoring method in pre-fibrotic stages of metabolic dysfunction-associated fatty liver disease (MASLD)
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Journal Article
FIB-4 as a screening and disease monitoring method in pre-fibrotic stages of metabolic dysfunction-associated fatty liver disease (MASLD)
2024
Overview
Guidelines emphasize screening high-risk patients for metabolic dysfunction-associated steatotic liver disease (MASLD) with a calculated FIB-4 score for therapy to reverse fibrosis. We aimed to determine whether FIB-4 can effectively screen and monitor changes in steatohepatitis (MASH).
Data were retrieved from the NIDDK-CR R4R central repository, of the CRN/PIVENS (pioglitazone vs vitamin E vs placebo) trial of adult patients without diabetes mellitus and with MASLD.
220 patients with MASLD had alanine transaminase (ALT), aspartate aminotransferase (AST) and platelet count, to calculate FIB-4, and repeat liver biopsies for histological MASLD activity scores (NAS). Compared to NAS score of 2, Fib-4 was higher at NAS 5) (p = 0.03), and NAS score of 6 (p = 0.02). FIB-4 correlated with cellular ballooning (r = 0.309, p < 0.001). Levels of ALT (ANOVA, p = 0.016) and AST (ANOVA p = 0.0008) were associated with NAS. NAS improved with pioglitazone by 39 %, p < 0.001 and with vitamin E by 36 %, p < 0.001. Pioglitazone and vitamin E both improved histological sub-scores for steatosis, and inflammation, without statistical changes in fibrosis grade. Changes in FIB-4 correlated with changes in NAS (r = 0.237, p < 0.001).
In this post hoc analysis, changes in FIB-4 were associated with changes of steatohepatitis. Medication known to treat steatohepatitis, may be considered, before the onset of advanced fibrosis.
•FIB-4 is used in metabolic dysfunction-associated steatotic liver disease (MASLD) to screen for fibrosis.•A post hoc review of the NIDDK-CR R4R central repository of CRN/PIVENS trial evaluated FIB-4 in pre-fibrotic steatohepatitis.•Changes in FIB-4 correlated with changes in histological steatohepatitis.•Therapies with pioglitazone and Vitamin E improved inflammation by 37 %–35 % without changes in fibrosis.•Medication known to treat steatohepatitis, may be considered, before the onset of advanced fibrosis
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Alanine Transaminase - blood
/ Aspartate Aminotransferases - blood
/ Biopsy
/ Datasets
/ Diabetes
/ Female
/ FIB-4
/ Humans
/ Hypoglycemic Agents - therapeutic use
/ Male
/ MASH
/ MASLD
/ NAFLD
/ NASH
/ Non-alcoholic Fatty Liver Disease - blood
/ Non-alcoholic Fatty Liver Disease - complications
/ Non-alcoholic Fatty Liver Disease - diagnosis
/ Non-alcoholic Fatty Liver Disease - pathology
/ Pioglitazone - therapeutic use
