Clinical Evaluation of FIB-4 (Fibrosis-4) Index in Patients with Hepatocellular Carcinoma at Ratchaburi Hospital
Keywords:
FIB-4 index, hepatocellular carcinomaAbstract
Objective: To evaluate the clinical characteristics and effectiveness of the FIB-4
(Fibrosis-4) index in assessing patients with hepatocellular carcinoma (HCC) within the context of a provincial hospital for optimizing its use in resource-limited settings
Methods: A retrospective descriptive study was conducted on 67 patients diagnosed with HCC at Ratchaburi Hospital between 2021 and 2025. The FIB-4 index was analyzed in correlation with clinical factors, including AFP, Child-Pugh score, MELD score, and BCLC stage.
Results: Cirrhosis was present in 70.1% of patients. The FIB-4 index showed a statistically significant correlation with age, platelet count, Child-Pugh and MELD scores, and HCC stage. Notably, 11 patients (16.4%) had low FIB-4 levels <1.45, of whom 27.3% presented with advanced-stage cancer and markedly elevated AFP levels. Multivariate analysis revealed that age over 65 years was a primary confounding factor significantly leading to overestimated FIB-4 values.
Conclusion: FIB-4 index <1.45 can’t always be used to exclude hepatocellular carcinoma. Clinical practice should integrate individual risk assessment with AFP levels and radiological imaging for comprehensive HCC screening.
References
World Health Organization. GLOBOCAN 2020: Liver Cancer Fact Sheet. Geneva: WHO Global Cancer Observatory; 2020.
Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317–25. doi: 10.1002/hep.21178.
Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty live disease. Hepatology. 2023;77(5):1797–835. doi: 10.1097/HEP.0000000000000323
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2022;76(1):229–64.
The Thai Association for the Study of the Liver (THASL). Clinical Practice Guidelines for Hepatocellular Carcinoma (HCC). Bangkok: THASL; 2025.
Suh B, Park S, Shin DW, Yun JM, Yang HK, Yu SJ, et al. High liver fibrosis index FIB-4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers. Hepatology. 2015;61(4):1261–8. doi: 10.1002/hep.27654.
Tseng CT, Liu CJ, Su TH, Yang WT, Chen CL, Yang HC, et al. Fibrosis-4 index helps identify HBV carriers with the lowest risk of hepatocellular carcinoma. Am J Gastroenterol. 2017;112(10):1564–74. doi: 10.1038/ajg.2017.254.
McPherson S, Hardy T, Dufour JF, Petta S, Romero-Gomez M, Allison M, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112(5):740–51. doi: 10.1038/ajg.2016.453.
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