FIB-4 score in young healthy adults and its association with end stage liver disease: a nationwide retrospective study

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and underdiagnosed among young healthy adults, with or without metabolic syndrome. This study assessed whether FIB-4 scores in young healthy adults are associated with incident end stage liver disease (LD). Methods: This retrospective study was conducted using a nationwide community and hospital database. Included were young adults, ages 18-40, with a FIB-4 score calculated during 2005–2020. People diagnosed with liver metastasis or chronic LD, other than MASLD, before or during the study, were excluded. The primary outcome was the first diagnosis of cirrhosis, cirrhosis-related complications, or hepatocellular carcinoma. Cox proportional models were applied, with FIB-4 score categorized by percentiles. Results: There were 430 incident cases of end stage LD in 11,057,421 person-years (mean age at diagnosis 30.0 ± 5.3 years). FIB-4 score was associated with incident end stage LD. After adjusting for multiple confounders, people with FIB-4 in the 75th–94th, 95th–98th and ≥ 99th percentiles were 35%, 140% and 760% more likely to develop end stage LD, respectively, compared to people with FIB-4 score in the 5th–49th percentiles. Each point of FIB-4 score was associated with a 2.2-fold greater risk of incident end stage LD (adjusted hazard ratio= 2.21 (95% CI 1.91-2.56). Conclusions: FIB-4 score is associated with increased risk for end stage LD in young healthy adults.