Liver Fibrosis Indices for the Prediction of Mortality in Korean Subjects: A 16-Year Prospective Cohort Study

Context: Nonalcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis are related to higher mortality. Objective: We investigated whether noninvasive indices of NAFLD and liver fibrosis could predict mortality in a Korean prospective cohort study. Methods: We followed 4163 subjects from the Korean Genome and Epidemiology Study biannually over 16 years. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) of NAFLD or liver fibrosis indices in the total group of subjects and subgroups according to body mass index (BMI) and glucose metabolism status. Results: The mean age ( SD) of the subjects was 55.7 8.7 years and 39.2% were men. During a median follow-up period of 15.6 years, 643 subjects (15.4%) died. The Fibrosis-4 (FIB-4), NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index were consistently higher in deceased subjects regardless of baseline glucose metabolism status. The FIB-4 and NFS displayed acceptable discrimination power for mortality, with area under the receiver operating characteristic curve values of 0.686 and 0.666, respectively. The adjusted HRs for FIB-4 and NFS were 1.41 (95% CI, 1.18-1.68) and 1.43 (95% CI, 1.21-1.68), respectively. Both FIB-4 and NFS were significantly associated with liver-specific mortality but not cardiovascular mortality. The association between mortality with fibrosis indices were more prominent in subjects with a lower BMI (<25 kg/m2). Conclusion: Noninvasive indices of liver fibrosis might be a significant predictor of allcause and liver-specific mortality in Korean subjects.