{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T16:01:58Z","timestamp":1766073718052,"version":"3.48.0"},"reference-count":7,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-0615_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether the diagnostic accuracy of the liver fibrosis marker FIB-4 and the likelihood ratios (LRs) of specific FIB-4 values vary with\u00a0age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0615_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a published dataset of 540 patients diagnosed with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis. Liver biopsy showed no or early fibrosis in 391 patients, and advanced fibrosis in 149. For each group we established the relation between the mean of the natural logarithm of FIB-4 (log(FIB-4)) and age, and the standard deviation (SD) of log(FIB-4) and age. Using a parametric method, we calculated the area under the ROC curve of FIB-4 as a function of the difference in mean values of log(FIB-4) between the two groups, and the ratio of the SDs of log(FIB-4). LRs were calculated as functions of age at 35, 50 and 65\u00a0years, using a parametric method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0615_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean log(FIB-4) increased with age in both groups. The SDs of log(FIB-4) did not change with age. There was a trend towards decreasing diagnostic accuracy with age, but this finding did not reach statistical significance. The area under the ROC curve was 0.73 using a parametric method that accounted for age, and 0.79 using a traditional non-parametric method that did not account for age. The LRs of specific FIB-4 values decreased with\u00a0age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-0615_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Age distorts the estimation of both diagnostic accuracy and\u00a0LRs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-0615","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T09:56:35Z","timestamp":1756115795000},"page":"154-157","source":"Crossref","is-referenced-by-count":0,"title":["Age distorts the interpretation of FIB-4"],"prefix":"10.1515","volume":"64","author":[{"given":"Arne","family":"\u00c5sberg","sequence":"first","affiliation":[{"name":"Department of Clinical Chemistry , St. Olav\u2019s Hospital , Trondheim , Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunhild Garmo","family":"Hov","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , St. Olav\u2019s Hospital , Trondheim , Norway"},{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology , Trondheim , Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena","family":"L\u00f8fblad","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , St. Olav\u2019s Hospital , Trondheim , Norway"},{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology , Trondheim , Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"2025121815555027137_j_cclm-2025-0615_ref_001","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J\u00a0Hepatol 2024;81:492\u2013542. https:\/\/doi.org\/10.1016\/j.jhep.2024.04.031.","DOI":"10.1016\/j.jhep.2024.04.031"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_002","doi-asserted-by":"crossref","unstructured":"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;112:740\u201351. https:\/\/doi.org\/10.1038\/ajg.2016.453.","DOI":"10.1038\/ajg.2016.453"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_003","doi-asserted-by":"crossref","unstructured":"Grimes, DA, Schulz, KF. Refining clinical diagnosis with likelihood ratios. Lancet 2005;365:1500\u20135. https:\/\/doi.org\/10.1016\/s0140-6736(05)66422-7.","DOI":"10.1016\/S0140-6736(05)66422-7"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_004","doi-asserted-by":"crossref","unstructured":"Sang, C, Yan, H, Chan, WK, Zhu, X, Sun, T, Chang, X, et al.. Diagnosis of fibrosis using blood markers and logistic regression in Southeast Asian patients with non-alcoholic fatty liver disease. Front Med (Lausanne) 2021;8:637652. https:\/\/doi.org\/10.3389\/fmed.2021.637652.","DOI":"10.3389\/fmed.2021.637652"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_005","doi-asserted-by":"crossref","unstructured":"Krzanowski, WJ, Hand, DJ. ROC curves for continuous data. London: CRC Press, Taylor & Francis Group; 2009:17\u201335 pp.","DOI":"10.1201\/9781439800225"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_006","doi-asserted-by":"crossref","unstructured":"\u00c5sberg, A, Bolann, BJ. The optimal cut-off value. Clin Chim Acta 2025;565:119953. https:\/\/doi.org\/10.1016\/j.cca.2024.119953.","DOI":"10.1016\/j.cca.2024.119953"},{"key":"2025121815555027137_j_cclm-2025-0615_ref_007","doi-asserted-by":"crossref","unstructured":"\u00c5sberg, A, L\u00f8fblad, L, Hov, GG. The likelihood ratios of FIB-4-values for diagnosing advanced liver fibrosis in patients with NAFLD. Clin Chem Lab Med 2023;61:e233\u20134. https:\/\/doi.org\/10.1515\/cclm-2023-0177.","DOI":"10.1515\/cclm-2023-0177"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0615\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0615\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T15:56:35Z","timestamp":1766073395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0615\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,23]]},"published-print":{"date-parts":[[2026,1,27]]}},"alternative-id":["10.1515\/cclm-2025-0615"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2025-0615","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"type":"print","value":"1434-6621"},{"type":"electronic","value":"1437-4331"}],"subject":[],"published":{"date-parts":[[2025,8,26]]}}}