Talks
Presenting Author Academic/Professional Position
Resident
Academic/Professional Position (Other)
Resident/PGY-2
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Faculty
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Community Partner
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Faculty
Discipline/Specialty (Author 4)
Internal Medicine
Presentation Type
Oral Presentation
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD), including metabolic dysfunction–associated steatohepatitis (MASH), is a leading cause of chronic liver disease worldwide. Current guidelines recommend fibrosis-based risk stratification using noninvasive tools such as the Fibrosis-4 (FIB-4) index in patients with metabolic risk factors, followed by secondary assessment (e.g., transient elastography or enhanced liver fibrosis(ELF) testing) for those with elevated scores. However, data on the real-world prevalence of elevated FIB-4 in U.S. primary care populations, particularly in safety-net settings, and the downstream implications for fibrosis evaluation remain limited. We aimed to quantify the burden of elevated FIB-4 in a primary care setting and to identify simple, readily available predictors to inform fibrosis risk triage.
Methods: We conducted a retrospective cross-sectional study of adults aged years attending an outpatient clinic within the University of Texas Rio Grande Valley system. Patients with available laboratory data to calculate FIB-4 (age, AST, ALT, platelets) were included in the analytic cohort, and FIB-4 scores were categorized using standard cutoffs: low risk (< 1.3), indeterminate risk (1.3–2.67), and high risk (>2.67). Demographics and metabolic risk factors—including hypertension, type 2 diabetes, dyslipidemia, obesity, and overall metabolic comorbidity burden—were assessed, and multivariable logistic regression models evaluated independent associations with elevated FIB-4 (≥1.3) and high-risk FIB-4 (>2.67), focusing on predictors relevant to primary-care screening workflows.
Results: Among 8,555 adults seen in the clinic, 1,728 patients (20.2%) had complete laboratory data to calculate FIB-4. In this analytic cohort, approximately 1 in 8 patients (13.0%, 223/1,728) had FIB-4 ≥1.3, and about 1 in 60 (1.6%, 28/1,728) had high-risk FIB-4 >2.67; in the total clinic population, these corresponded to 2.6% and 0.3% of all patients, respectively. Age demonstrated a strong, graded association with fibrosis risk, with nearly 30% of patients aged 60–69 years exhibiting FIB-4 ≥1.3, and male sex was independently associated with both elevated and high-risk FIB-4. Hypertension emerged as the strongest independent predictor of high-risk FIB-4, conferring more than a 4-fold increase in odds, while a higher cumulative metabolic comorbidity burden was associated with a progressively greater prevalence of elevated FIB-4, reinforcing the need to prioritize screening in patients with multiple metabolic risk factors.
Conclusions: In this primary care population, a substantial proportion of metabolically at-risk patients had elevated FIB-4 scores, indicating a meaningful burden of suspected advanced hepatic fibrosis. Older age, male sex, hypertension, and cumulative metabolic risk were the most clinically relevant predictors of elevated FIB-4, highlighting a small but high-need subset of primary-care patients. Embedding routine FIB-4 calculation into primary-care laboratory workflows—particularly for older, hypertensive patients with multiple metabolic risk factors—may efficiently identify those who warrant secondary fibrosis assessment with FibroScan or ELF testing and timely hepatology referral, with important implications for resource-limited and safety-net settings.
Recommended Citation
Lawal, Ridwan Ademola; Bello, Fatimah; Patil, Rashmee; and Yang, Juliana, "High Burden of Elevated FIB-4 in Metabolically At-Risk Primary Care Patients: Simple Predictors to Guide Hepatic Fibrosis Triage" (2026). Research Symposium. 11.
https://scholarworks.utrgv.edu/somrs/2026/talks/11
Included in
Digestive, Oral, and Skin Physiology Commons, Gastroenterology Commons, Hepatology Commons
High Burden of Elevated FIB-4 in Metabolically At-Risk Primary Care Patients: Simple Predictors to Guide Hepatic Fibrosis Triage
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD), including metabolic dysfunction–associated steatohepatitis (MASH), is a leading cause of chronic liver disease worldwide. Current guidelines recommend fibrosis-based risk stratification using noninvasive tools such as the Fibrosis-4 (FIB-4) index in patients with metabolic risk factors, followed by secondary assessment (e.g., transient elastography or enhanced liver fibrosis(ELF) testing) for those with elevated scores. However, data on the real-world prevalence of elevated FIB-4 in U.S. primary care populations, particularly in safety-net settings, and the downstream implications for fibrosis evaluation remain limited. We aimed to quantify the burden of elevated FIB-4 in a primary care setting and to identify simple, readily available predictors to inform fibrosis risk triage.
Methods: We conducted a retrospective cross-sectional study of adults aged years attending an outpatient clinic within the University of Texas Rio Grande Valley system. Patients with available laboratory data to calculate FIB-4 (age, AST, ALT, platelets) were included in the analytic cohort, and FIB-4 scores were categorized using standard cutoffs: low risk (< 1.3), indeterminate risk (1.3–2.67), and high risk (>2.67). Demographics and metabolic risk factors—including hypertension, type 2 diabetes, dyslipidemia, obesity, and overall metabolic comorbidity burden—were assessed, and multivariable logistic regression models evaluated independent associations with elevated FIB-4 (≥1.3) and high-risk FIB-4 (>2.67), focusing on predictors relevant to primary-care screening workflows.
Results: Among 8,555 adults seen in the clinic, 1,728 patients (20.2%) had complete laboratory data to calculate FIB-4. In this analytic cohort, approximately 1 in 8 patients (13.0%, 223/1,728) had FIB-4 ≥1.3, and about 1 in 60 (1.6%, 28/1,728) had high-risk FIB-4 >2.67; in the total clinic population, these corresponded to 2.6% and 0.3% of all patients, respectively. Age demonstrated a strong, graded association with fibrosis risk, with nearly 30% of patients aged 60–69 years exhibiting FIB-4 ≥1.3, and male sex was independently associated with both elevated and high-risk FIB-4. Hypertension emerged as the strongest independent predictor of high-risk FIB-4, conferring more than a 4-fold increase in odds, while a higher cumulative metabolic comorbidity burden was associated with a progressively greater prevalence of elevated FIB-4, reinforcing the need to prioritize screening in patients with multiple metabolic risk factors.
Conclusions: In this primary care population, a substantial proportion of metabolically at-risk patients had elevated FIB-4 scores, indicating a meaningful burden of suspected advanced hepatic fibrosis. Older age, male sex, hypertension, and cumulative metabolic risk were the most clinically relevant predictors of elevated FIB-4, highlighting a small but high-need subset of primary-care patients. Embedding routine FIB-4 calculation into primary-care laboratory workflows—particularly for older, hypertensive patients with multiple metabolic risk factors—may efficiently identify those who warrant secondary fibrosis assessment with FibroScan or ELF testing and timely hepatology referral, with important implications for resource-limited and safety-net settings.
