Screening
Liver Fibrosis Scores and Mortality in the Combined Cohort of World Trade Center Rescue/Recovery Workers Ankura Singh* Ankura Singh Rachel Zeig-Owens Nikolina Icitovic David G. Goldfarb Andrew C. Todd Christopher R. Dasaro Victoria Garrity David J. Prezant
Background
Higher liver fibrosis scores have been associated with elevated all-cause and liver disease-related mortality. We investigated whether liver fibrosis scores were associated with all-cause, liver disease-related and non-liver disease-related mortality as well as liver cancer incidence in workers who responded to the World Trade Center (WTC) on 9/11/01 (9/11).
Methods
The study included 43,870 WTC responders who were ≥18 on 9/11 and had blood drawn by 12/31/20 at a post-9/11 health exam. Aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 score (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS) were calculated and categorized as low, intermediate or high fibrosis scores per established cutoffs. Deaths and liver cancer cases were identified via National Death Index records and state cancer registries, respectively. Cox proportional hazards regression models estimated HRs and 95% CIs for each outcome in those with intermediate and high vs low fibrosis scores, adjusting for sex, race, age, body mass index, smoking and alcohol use.
Results
There were 1,996 deaths, 81 liver disease-related deaths and 36 incident liver cancers in the cohort by 12/31/20. Participants with intermediate or high APRI (HR=1.73 CI=1.50-1.99 & HR=7.23 CI=5.63-9.29), FIB-4 (HR=1.18 CI=1.05-1.34 & HR=3.96 CI=3.22-4.85), or NFS (HR=1.61 CI=1.43-1.81 & HR=4.73 CI=3.78-5.93) had significantly greater risks of overall mortality vs those with low scores. Liver disease- and non-liver disease-related deaths were also elevated in those with intermediate or high scores. High APRI, FIB-4 and NFS and intermediate APRI and NFS were associated with liver cancer.
Conclusion
Intermediate and high liver fibrosis scores predicted all-cause, liver disease-related and non-liver disease-related mortality and high scores predicted liver cancer in WTC responders. Liver fibrosis scores may identify those at greater risk for mortality and liver cancer, even in a healthy worker cohort.