{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:07:46Z","timestamp":1792080466590,"version":"4.4.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>\n                    Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, and its prevalence continues to rise. Fibrosis\u20104 index (FIB\u20104) has been shown to be a prognostic marker of liver\u2010related outcomes in patients with NAFLD. We analyzed data from TriNetX global federated research network, combining data on 30 million patients. Patients were categorized into three diagnostic groups: NAFLD, nonalcoholic steatohepatitis (NASH), and at risk of NASH. Primary outcome was all\u2010cause mortality, and secondary outcomes included progression to NASH, development of cirrhosis, end\u2010stage liver disease, hepatocellular carcinoma (HCC), and liver transplantation. A total of 442,277 subjects (1.5% of the cohort) were assessed, and 81,108 were retained for analysis. Median follow\u2010up was 34.8 months (interquartile range 12.2). FIB\u20104 was &lt; 1.3 in 52.3% patients and \u2265 2.67 in 11.4% patients. In multivariate analysis, FIB\u20104 \u2265 2.67 was significantly and independently associated with all\u2010cause mortality (hazard ratio [HR] 2.49, 95% confidence interval [CI] 2.20\u20102.82,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001) as well as with progression to NASH (HR 5.78, 95% CI 4.72\u20107.07,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001), cirrhosis (HR 2.04, 95% CI 1.86\u20102.24,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001), end\u2010stage liver disease (HR 1.86, 95% CI 1.68\u20102.05,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001), HCC (HR 3.66, 95% CI 2.71\u20104.94,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001), and liver transplantation (HR 7.98, 95% CI 4.62\u201013.79,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001).\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    In a real\u2010world nationwide database, FIB\u20104 \u2265 2.67 was a strong predictor of both all\u2010cause mortality and liver\u2010related adverse outcomes independently of the baseline diagnostic group and common risk factors. Our findings indicate that FIB\u20104 could play a role as a risk\u2010stratification tool for a population health approach. Significant underdiagnosis of both NAFLD\/NASH and NASH cirrhosis in electronic medical records was observed.\n                  <\/jats:p>","DOI":"10.1002\/hep4.1841","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T01:54:26Z","timestamp":1640915666000},"page":"765-779","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":93,"title":["Fibrosis\u20104 Index as an Independent Predictor of Mortality and Liver\u2010Related Outcomes in NAFLD"],"prefix":"10.1097","volume":"6","author":[{"given":"Joana","family":"Vieira Barbosa","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Beth Israel Deaconess Medical Center,Harvard Medical School,Boston,MA,USA"},{"name":"Division of Gastroenterology and Hepatology,Lausanne University Hospital and University of Lausanne,Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Milligan","sequence":"additional","affiliation":[{"name":"Trio Health Analytics,Cypress,TX,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Frick","sequence":"additional","affiliation":[{"name":"Trio Health Analytics,Cypress,TX,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Broestl","sequence":"additional","affiliation":[{"name":"Trio Health Analytics,Cypress,TX,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9313-577X","authenticated-orcid":false,"given":"Zobair","family":"Younossi","sequence":"additional","affiliation":[{"name":"Center for Liver Diseases,Department of Medicine,Inova Fairfax Hospital,Falls Church,VA,USA"},{"name":"Betty and Guy Beatty Center for Integrated Research,Inova Health System,Falls Church,VA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nezam H.","family":"Afdhal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Beth Israel Deaconess Medical Center,Harvard Medical School,Boston,MA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Beth Israel Deaconess Medical Center,Harvard Medical School,Boston,MA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"hep41841-bib-0001-20241115","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/gutjnl-2019-318813","article-title":"Epidemiology of chronic liver diseases in the USA in the past three 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