Prospective screening for significant liver fibrosis by fibrosis-4 in primary care patients without known liver disease

BACKGROUND: Fibrosis-4 test (FIB-4) is one of the simplest, free of charge, noninvasive scoring tests. We aimed to prospectively measure the prevalence of liver fibrosis in adults with no previously known liver disease and who consulted a general practitioner by FIB-4 score; compare this test to an NAFLD Fibrosis Score (NFS) and Fibrometer (FM); explore the prevalence of risk factors (obesity, diabetes, alcohol, and hypertension) and reconsider a possible cause of liver disease in patients recognized as FIB-4-positive. METHODS: Over a 6-month period, 40 general practitioners (GPs) offered all their consecutive adult primary care patients with no previously known liver pathology and a liver fibrosis screening via a blood test of three scores. RESULTS: Among the consecutive 2121 patients included in the study, 39% had a BMI greater than 25 kg/m(2), 13% had an alcohol consumption greater than 100 g/week, 10% had type 2 diabetes, and 29% had hypertension. The prevalence of significant liver fibrosis by FIB-4, according to age was 19.1% (95% confidence interval: 17.5–20.9%). By comparison, prevalence was 16.8% (15.0–18.5%) by the NFS and 8.2% (6.9–9.6%) by the FM. A significant relationship was observed between FIB-4 fibrosis risk stages and NFS and FM scores. GPs identified the cause of disease in 2/3 of FIB-4-positive cases, mainly nonalcoholic steatohepatitis. CONCLUSION: Liver fibrosis was suspected by FIB-4 score in 19.1% of patients with no previously known liver disease. The detection of significant fibrosis by the FIB-4 allowed the GP to suspect liver disease. The FIB-4 score that can be automatically generated should allow earlier recognition of liver disease in the general population.