Abstract：
BACKGROUND: Effective screening for alcohol-associated liver disease is relevant in the context of chronic, excessive alcohol consumption. Patients with alcohol-associated liver disease are often not diagnosed until their liver disease is decompensated. We analyzed the prevalence and associations of Fibrosis-4 index (FIB-4) values suggestive of advanced liver fibrosis in patients referred for their first treatment of alcohol use disorder (AUD).
METHODS: We conducted a cross-sectional, multicenter study of noncirrhotic individuals referred for their first AUD treatment between March 2013 and April 2021. We obtained sociodemographic data, substance use characteristics, and blood samples at admission. We considered a FIB-4 value ≥2.67 suggestive of advanced liver fibrosis and used logistic regression analyses to identify features associated with this value.
RESULTS: We included 604 patients (67% male), with a median age at admission of 48 years [IQR: 41-56 years]. The median duration of regular alcohol consumption was 21 years [IQR: 18-30 years] and the median alcohol consumption was 105 standard drink units (SDU)/week [IQR: 63-160 SDU/week]. A FIB-4 value ≥ 2.67 was present in 19.3% of cases. These patients reported more frequent binge drinking (75.4% vs. 66%, p = 0.05) than those with FIB-4 values below 2.67. In multivariate analysis, a history of binge drinking (OR 1.9, 95% CI, 1.05-3.47), anemia (OR 2.95, 95% CI, 1.42-6.11), leukopenia (OR 7.46, 95% CI, 2.07-26.8), and total serum bilirubin >1 mg/dL (OR 6.46, 95% CI, 3.57-11.7) were independently associated with FIB-4 values ≥2.67.
CONCLUSIONS: One in five patients admitted to treatment for AUD without evidence of decompensated liver disease have FIB-4 values suggestive of advanced liver fibrosis. The presence of a binge drinking history, anemia, leukopenia, and elevated bilirubin levels is associated with high FIB-4 values.
METHODS: We conducted a cross-sectional, multicenter study of noncirrhotic individuals referred for their first AUD treatment between March 2013 and April 2021. We obtained sociodemographic data, substance use characteristics, and blood samples at admission. We considered a FIB-4 value ≥2.67 suggestive of advanced liver fibrosis and used logistic regression analyses to identify features associated with this value.
RESULTS: We included 604 patients (67% male), with a median age at admission of 48 years [IQR: 41-56 years]. The median duration of regular alcohol consumption was 21 years [IQR: 18-30 years] and the median alcohol consumption was 105 standard drink units (SDU)/week [IQR: 63-160 SDU/week]. A FIB-4 value ≥ 2.67 was present in 19.3% of cases. These patients reported more frequent binge drinking (75.4% vs. 66%, p = 0.05) than those with FIB-4 values below 2.67. In multivariate analysis, a history of binge drinking (OR 1.9, 95% CI, 1.05-3.47), anemia (OR 2.95, 95% CI, 1.42-6.11), leukopenia (OR 7.46, 95% CI, 2.07-26.8), and total serum bilirubin >1 mg/dL (OR 6.46, 95% CI, 3.57-11.7) were independently associated with FIB-4 values ≥2.67.
CONCLUSIONS: One in five patients admitted to treatment for AUD without evidence of decompensated liver disease have FIB-4 values suggestive of advanced liver fibrosis. The presence of a binge drinking history, anemia, leukopenia, and elevated bilirubin levels is associated with high FIB-4 values.
摘要：
背景：酒精相关性肝病的有效筛查在慢性，过度饮酒。患有酒精相关肝病的患者通常在他们的肝病失代偿之前才被诊断出来。我们分析了纤维化-4指数（FIB-4）值的患病率和关联，这些值提示晚期肝纤维化患者首次治疗酒精使用障碍（AUD）。
方法：我们进行了横截面，2013年3月至2021年4月期间首次接受AUD治疗的非肝硬化个体的多中心研究。我们获得了社会人口统计数据，物质使用特征，入院时的血液样本。我们认为FIB-4值≥2.67提示晚期肝纤维化，并使用逻辑回归分析来确定与该值相关的特征。
结果：我们包括604名患者（67％为男性），入院年龄中位数为48岁[IQR：41-56岁]。定期饮酒的中位持续时间为21年[IQR：18-30年]，饮酒中位数为105标准饮料单位（SDU）/周[IQR：63-160SDU/周]。19.3%的病例存在FIB-4值≥2.67。这些患者报告更频繁地暴饮暴食（75.4％vs.66%,p=0.05）比FIB-4值低于2.67的那些。在多变量分析中，暴饮暴食史（OR1.9，95%CI，1.05-3.47），贫血（OR2.95，95%CI，1.42-6.11），白细胞减少症（OR7.46，95%CI，2.07-26.8），血清总胆红素>1mg/dL（OR6.46，95％CI，3.57-11.7）与FIB-4值≥2.67独立相关。
结论：在无失代偿性肝病证据的情况下接受AUD治疗的患者中有五分之一的FIB-4值提示晚期肝纤维化。酗酒史的存在，贫血,白细胞减少症,胆红素水平升高与高FIB-4值相关。
方法：我们进行了横截面，2013年3月至2021年4月期间首次接受AUD治疗的非肝硬化个体的多中心研究。我们获得了社会人口统计数据，物质使用特征，入院时的血液样本。我们认为FIB-4值≥2.67提示晚期肝纤维化，并使用逻辑回归分析来确定与该值相关的特征。
结果：我们包括604名患者（67％为男性），入院年龄中位数为48岁[IQR：41-56岁]。定期饮酒的中位持续时间为21年[IQR：18-30年]，饮酒中位数为105标准饮料单位（SDU）/周[IQR：63-160SDU/周]。19.3%的病例存在FIB-4值≥2.67。这些患者报告更频繁地暴饮暴食（75.4％vs.66%,p=0.05）比FIB-4值低于2.67的那些。在多变量分析中，暴饮暴食史（OR1.9，95%CI，1.05-3.47），贫血（OR2.95，95%CI，1.42-6.11），白细胞减少症（OR7.46，95%CI，2.07-26.8），血清总胆红素>1mg/dL（OR6.46，95％CI，3.57-11.7）与FIB-4值≥2.67独立相关。
结论：在无失代偿性肝病证据的情况下接受AUD治疗的患者中有五分之一的FIB-4值提示晚期肝纤维化。酗酒史的存在，贫血,白细胞减少症,胆红素水平升高与高FIB-4值相关。
