FIB-4 predicts events in compensated advanced chronic liver disease and type 2 diabetes treated with GLP-1-receptor-agonists

Feb 25, 2025Journal of diabetes and its complications

FIB-4 predicts health events in advanced liver disease and type 2 diabetes treated with GLP-1 receptor drugs

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Abstract

The Fibrosis-4 index (FIB-4) is associated with an increased risk of liver-related events in patients with compensated advanced chronic liver disease and treated type 2 diabetes.

FIB-4 is linked to hepatic decompensation, liver transplantation, and death, with a hazard ratio of 1.517.
An association exists between FIB-4 and the development of hepatocellular carcinoma, indicated by a hazard ratio of 1.369.
Bacterial infections are also associated with FIB-4, with a hazard ratio of 1.379.
No significant effect of adding GLP-1 receptor agonists to diabetes treatment was observed for these outcomes.
Patients with more advanced disease (FIB-4 > 2.67) have worse survival rates.

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BACKGROUND & AIMS: Patients with compensated advanced chronic liver disease (cACLD) and treated type 2 diabetes have an increased risk for liver-related events, but data regarding this population is lacking, particularly, taking into account novel treatments. We assessed the role of Fibrosis-4 index and other variables to predict events.

METHODS: First hepatic decompensation, liver transplantation (OLT), death, hepatocellular carcinoma (HCC) and bacterial infections over a follow-up period of 28.7 (16-49.4) months were retrospectively identified from 106 patients with treated type 2 diabetes and liver stiffness measurement >10 kPa suggesting ACLD. We identified predictors of events using Cox regression. Additionally, we evaluated treatment effect with add-on GLP-1 receptor agonists (GLP-1-RA) compared to other antidiabetic medications.

RESULTS: FIB-4 was associated with hepatic decompensation, OLT and death (HR 1.517, 95%CI 1.226-1.879, p ≤ 0.001), HCC (HR 1.369, 95%CI 1.046-1.791, p = 0.022) and bacterial infections (HR 1.379, 95%CI 1.118-1.702, p = 0.003). Propensity score adjusted analysis for GLP-1-RA treatment did not show an effect (HR 0.240, 95%CI 0.044-1.315, p = 0.1). Survival was worse in those with more advanced disease defined by FIB-4 > 2.67 (p = 0.02).

CONCLUSION: FIB-4 is a strong prognostic tool to screen patients and refer them to specialists, in cACLD patients and pharmacologically treated type 2 diabetes, irrespective of treatment.

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FIB-4 predicts events in compensated advanced chronic liver disease and type 2 diabetes treated with GLP-1-receptor-agonists

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