Elevated Fatty Liver Index as a Risk Factor for All‐Cause Mortality in Human Immunodeficiency Virus–Hepatitis C Virus–Coinfected Patients (ANRS CO13 HEPAVIH Cohort Study)

Abstract

Background and Aims Human immunodeficiency virus (HIV)–hepatitis C virus (HCV)–coinfected patients are at high risk of metabolic complications and liver‐related events, which are both associated with hepatic steatosis and its progressive form, nonalcoholic steatohepatitis, a known risk factor for mortality. The fatty liver index (FLI), a noninvasive steatosis biomarker, has recently drawn attention for its clinical prognostic value, although its capacity to predict mortality risk in HIV–HCV‐coinfected patients has never been investigated. Using a Cox proportional hazards model for mortality from all causes, with data from the French National Agency for Research on Aids and Viral Hepatitis CO13 HEPAVIH cohort (983 patients, 4,432 visits), we tested whether elevated FLI (≥60) was associated with all‐cause mortality. Approach and Results After multiple adjustment, individuals with FLI ≥ 60 had almost double the risk of all‐cause mortality (adjusted hazard ratio [95% confidence interval], 1.91 [1.17‐3.12], P = 0.009), independently of the following factors: HCV cure (0.21 [0.07‐0.61], P = 0.004), advanced fibrosis (1.77 [1.00‐3.14], P = 0.05), history of hepatocellular carcinoma and/or liver transplantation (7.74 [3.82‐15.69], P < 10−3), history of indirect clinical signs of cirrhosis (2.80 [1.22‐6.41], P = 0.015), and HIV Centers for Disease Control and Prevention clinical stage C (2.88 [1.74‐4.79], P < 10−3). Conclusions An elevated FLI (≥60) is a risk factor for all‐cause mortality in HIV–HCV‐coinfected patients independently of liver fibrosis and HCV cure. In the present era of nearly 100% HCV cure rates thanks to direct‐acting antivirals, these findings encourage the more systematic use of noninvasive steatosis biomarkers to help identify coinfected patients with higher mortality risk.

Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients

“…The FLI has been widely validated and shown acceptable diagnostic accuracy, 49 so this surrogate can be considered appropriate for our large‐scale cohort study. In other studies, the FLI was independently associated with the outcomes of patients with non‐alcoholic fatty liver disease, 50 and those with HIV‐HCV‐coinfection 51 . However, the FLI was developed using ultrasound data as the reference, not histological data 49 .…”

“…In other studies, the FLI was independently associated with the outcomes of patients with non-alcoholic fatty liver disease, 50 and those with HIV-HCV-coinfection. 51 However, the FLI was developed using ultrasound data as the reference, not histological data. 49 Additionally, even using a high FLI cut-off of 60 for predicting fatty liver had a sensitivity of 60-70%, 52 suggesting that misclassification of the true presence of fatty liver could not be avoided.…”

Fatty Liver Index Independently Predicts All-Cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis but No Substantial Liver Disease

“…Although this index was initially created to assess the presence and degree of hepatic steatosis in individuals, FLI recently has been also considered an emerging marker of chronic inflammation-related cardiovascular disease regarding the close association between hepatic steatosis subclinical atherosclerosis. On the other hand, to date, the predictive potential of the FLI for CVD and all-cause mortality has been reported in the various ethnic population or patients with diverse diseases (16)(17)(18)(19). Moreover, the FLI was also reportedly associated with the risk of CVD and all-cause mortality in the general Korean population (20,21).…”

An elevated liver fibrosis index FIB 4 score is associated with poor clinical outcomes in patients with sepsis: an observational cohort study

“…However, no previous study has investigated the association between sub-clinical hepatic fibrosis and sepsis, especially for prognosis. Several non-invasive fibrosis scoring systems, such as the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) score, and NAFLD fibrosis score (NFS) [16,17,18], are widely used to evaluate the risk of poor prognosis in chronic liver disease [19,20], cardiovascular and cerebrovascular diseases [21,22], and malignant tumors [23,24]. Therefore, the purpose of our study was to explore the potential association of liver fibrosis indexes with the outcomes of septic patients without overt chronic liver disease.…”