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High FIB-4 index as an independent risk factor of prevalent chronic kidney disease in patients with nonalcoholic fatty liver disease

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Abstract

Background

Growing evidence suggests that non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk for chronic kidney disease (CKD); liver fibrosis with biopsy-proven NAFLD has also been shown to associate with an increased risk of CKD. This study compares the diagnostic performance of simple noninvasive tests in identifying prevalent CKD among individuals with ultrasonography-diagnosed NAFLD.

Methods

A total of 755 with ultrasonography-diagnosed NAFLD were included. Estimated glomerular filtration rate and noninvasive markers for hepatic fibrosis: aspartate transaminase to alanine transaminase ratio (AAR), aspartate transaminase to platelet ratio index (APRI), FIB-4 score, NAFLD fibrosis score (NFS) and BARD score were assessed.

Results

Binary logistic regression to generate a propensity score and receiver operating characteristic curves were developed for each of the noninvasive markers for predicting CKD, and the area under the receiver operating characteristic curve was greatest for FIB-4 score (0.750), followed by NFS (0.710), AAR (0.594), APRI (0.587), and BARD score (0.561). A cut-off value of 1.100 for FIB-4 score gave a sensitivity of 68.85 % and a specificity of 71.07 % for predicting CKD. The positive predictive value and negative predictive value were 37.50 and 90.05 %, respectively. In multiple logistic regression analysis, only FIB-4 score ≧1.100 (OR 2.660, 95 % CI 1.201–5.889; p = .016), older age, higher diastolic blood pressure and higher uric acid were independent predictors of CKD.

Conclusions

High noninvasive fibrosis score is associated with an increased risk of prevalent CKD; the FIB-4 is the better predictor. With a cut-off value of 1.100 for FIB-4, it is useful in excluding the presence of CKD in patients with NAFLD.

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Abbreviations

2-hour PPG:

2-Hour postprandial blood glucose test

AAR:

Aspartate transaminase to alanine transaminase ratio

ALT:

Alanine transaminase

APRI:

Aspartate transaminase to platelet ratio index

AST:

Aspartate transaminase

AUROC:

Area under the receiver operating characteristic curve

BMI:

Body mass index

CKD:

Chronic kidney disease

DBP:

Diastolic blood pressure

eGFR:

Estimated glomerular filtration rate

FPG:

Fasting plasma glucose

HDL:

High-density lipoprotein

IFG:

Impaired fasting glucose

LDL:

Low-density lipoprotein

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

NFS:

NAFLD fibrosis score

NPV:

Negative predictive values

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SBP:

Systolic blood pressure

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Acknowledgement

The authors acknowledge the support given by Chang Gung Memorial Hospital for the conducting of this study.

Author information

Authors and Affiliations

  1. Department of Nephrology and Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yung-Chien Hsu & Chun-Liang Lin

  2. School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan

    Chun-Liang Lin

  3. Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Huang-Wei Xu & Kuo-Liang Wei

  4. School of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan

    Chia-Hao Chang

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Correspondence to Chun-Liang Lin.

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Conflict of interest

Huang-Wei Xu, Yung-Chien Hsu, Chia-Hao Chang, Kuo-Liang Wei and Chun-Liang Lin declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. This article does not contain any studies with animal subjects. The Institutional Review Board waived the need for informed consent from the participants because this research was a retrospectively observational analysis, and the identifying information was not included in the collected data. This study was approved by the Institutional Review Board of the Chang Gung Memorial Hospital.

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Xu, HW., Hsu, YC., Chang, CH. et al. High FIB-4 index as an independent risk factor of prevalent chronic kidney disease in patients with nonalcoholic fatty liver disease. Hepatol Int 10, 340–346 (2016). https://doi.org/10.1007/s12072-015-9690-5

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  • DOI: https://doi.org/10.1007/s12072-015-9690-5

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