Evaluation of Liver Fibrosis Using Non-invasive Indices in the Bandar Kong Cohort Population, Hormozgan-Iran, During 2016–2018

Background: Liver fibrosis, regardless of the underlying cause of chronic liver diseases (CLDs), is the final result of repeated cellular necrosis and liver inflammation. Metabolic and viral factors constitute a significant portion of the etiology of fibrosis resulting from CLDs. Non-alcoholic fatty liver disease (NAFLD) is the main cause of CLD with a metabolic basis. Diagnosis is rarely made in the early stages, as the disease is often asymptomatic at this point, and no specific strategy has been developed to detect early-stage liver fibrosis. However, treatments in the early stages are more beneficial than in the later stages of CLDs. Therefore, identifying factors related to liver fibrosis is essential to improve health outcomes through proper education for individuals at higher risk. This study aimed to evaluate liver fibrosis based on non-invasive fibrosis indices in the Bandar Kong cohort population. Materials and Methods: This study was conducted on 3,886 individuals. After collecting demographic information, the fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), Forns, and body mass index (BMI), AST/alanine aminotransferase ratio, and diabetes (BARD) indices were calculated and recorded for each patient. Chi-square and independent t-tests were used to compare the data. Results: According to the FIB-4, APRI, Forns, and BARD indices, 0.8%, 2.1%, 3.1%, and 67.4% of the study population had advanced fibrosis, respectively. It was also found that based on the FIB-4 index, diabetes, considering age as an independent risk factor, increased the odds of uncertain liver fibrosis results by approximately 1.5 times. Additionally, the results indicated that age, BMI, and male gender are independent risk factors leading to advanced liver fibrosis. The APRI index showed that diabetes, as an independent risk factor, nearly doubled the odds of developing liver fibrosis. Moreover, the Forns index demonstrated that diabetes, when considering age and male gender as risk factors, could increase the likelihood of liver fibrosis by approximately threefold. The BARD index revealed that diabetes, considering age, BMI, and female gender as independent risk factors, increased liver fibrosis by approximately 20% (1.21 times). Conclusion: Based on the findings, non-invasive tests (NITs) may either overestimate or underestimate fibrosis, underscoring the need for further studies with biopsy results to achieve more accurate outcomes.