Prevalence of risk factors for liver fibrosis and associations of serum biomarkers with liver fibrosis in a Houston community clinic.
Authors: Hwang Jessica Park , Heredia Natalia I. , Asrani Sumeet , Foreman Jessica T. , Warneke Carla L. , Abraham Johannah , Ankoma-Sey Caroline , Ankoma-Sey Victor , Basen-Engquist Karen , Booker Aleah R. , Gambrill Carol , Green Kara , Harris Cassandra , Le Anh , Ma Jacqueline , McNeill Lorna H , Nguyen Lynne Huong , Torres Harrys A. , Caracostis Andrea 
Published: June 2023

e22518

Background: Liver fibrosis may lead to hepatocellular carcinoma (HCC). Hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, metabolic syndrome, and alcohol use disorder (AUD) are risk factors for fibrosis. Early screening for fibrosis using serum biomarkers in community settings is not well established. Methods: Adult patients at the HOPE Clinic, a federally qualified health care center in Houston, were enrolled from January 2021 through January 2023 and surveyed about risk factors for liver fibrosis. We measured vital signs and waist circumference, calculated body mass index (BMI), and performed blood testing. We defined chronic HBV infection as positivity for hepatitis B surface antigen; chronic HCV infection as detectable HCV RNA; metabolic syndrome as the presence of at least 3 of 4 conditions: hyperglycemia, hypertension, dyslipidemia, and obesity; and AUD as an AUDIT-C score of ≥4 for men and ≥3 for women. Transient elastrography was performed to assess for fibrosis, with scores ≥8 kPa indicating ≥F2 fibrosis. Serum biomarkers of fibrosis were defined as Fibrosis-4 (FIB-4) score ≥2.67 (based on ALT, AST, platelets, age); NAFLD Fibrosis Score (NFS) ≥0.675 (based on ALT, AST, platelets, albumin, age, BMI, diabetes); and Fatty Liver Index (FLI) ≥30 (based on triglycerides, gamma-glutamyl transferase, waist circumference, BMI). We described the prevalence of fibrosis risk factors and tested the associations of risk factors and serum biomarkers with ≥F2 fibrosis using Fisher’s exact test. Results: We enrolled 904 patients, 378 men (42%) and 526 women (58%). The median age was 48 years. A total of 456 patients (51%) were White, 245 (27%) were Asian, and 187 (21%) were Black. Among all patients, 365 (41%) were Hispanic. Forty-two percent of patients (n = 377) had BMI ≥30. Five percent of patients (46/869) had chronic HBV infection, < 1% (1/863) had chronic HCV infection, 49% (417/849) had metabolic syndrome, and 13% (115/896) had AUD. Of 826 patients who completed transient elastrography, 79 (10%) had ≥F2 fibrosis. Metabolic syndrome was significantly associated with ≥F2 fibrosis (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.5-4.1) but chronic HBV infection, chronic HCV infection, and AUD were not. Serum biomarkers were predictive of ≥F2 fibrosis: FIB-4 score ≥2.67 (OR 19.1, 95% CI 7.3-50.2); NFS ≥0.675 (OR 12.0, 95% CI 4.2-34.2); and FLI ≥30 (OR 5.9, 95% CI 1.4-25.0). Among patients with metabolic syndrome, FIB-4 score ≥2.67 (OR 22.0, 95% CI 4.3-112.0) and NFS ≥0.675 (OR 11.9, 95% CI 2.8-51.4) were predictive of ≥F2 fibrosis, but FLI ≥30 (OR 4.5, 95% CI 0.7-27.5) was not. Conclusions: In this ongoing community-based study, 1 in 10 patients had fibrosis. Metabolic syndrome was a significant risk factor for ≥F2 fibrosis, along with FIB-4 and NFS among patients with metabolic syndrome. Incorporating biomarkers into clinical algorithms will be useful to prevent HCC. Clinical trial information: NCT04785534 .