FIB-4 Score in Young Healthy Adults and Its Association With End Stage Liver Disease: A Nationwide Retrospective Study.

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and underdiagnosed among young healthy adults, with or without metabolic syndrome. This study assessed whether the Fibrosis-4 Index (FIB-4) in young healthy adults is associated with incident end-stage liver disease (ESLD). This retrospective study was conducted using a nationwide community and hospital database. Included were young adults, ages 18-40 years, with a FIB-4 score calculated during 2005-2020. People diagnosed with liver metastasis or chronic liver disease, other than MASLD, before or during the study, were excluded. The primary outcome was the first diagnosis of cirrhosis, cirrhosis-related complications, or hepatocellular carcinoma. Cox proportional models were applied, with FIB-4 score categorized by percentiles. There were 430 incident cases of ESLD in 11,057,421 person-years (mean age at diagnosis 30.0 ± 5.3 years). FIB-4 score was associated with incident ESLD. After adjusting for multiple confounders, people with FIB-4 in the 75th-94th, 95th-98 th , and ≥ 99th percentiles were 35%, 140%, and 760% more likely to develop ESLD, respectively, compared with people with FIB-4 score in the 5th-49th percentiles. Each point of FIB-4 score was associated with a 2.2-fold greater risk of incident ESLD (adjusted hazard ratio 2.21, 95% confidence interval 1.91-2.56). FIB-4 score is associated with increased risk of ESLD in young healthy adults.