Observation of risk factors for the progression of significant liver fibrosis F3~F4 in elderly patients with non-alcoholic fatty liver disease

Abstract

Abstract: Objective To explore the risk factors for the progression of liver fibrosis to stages F3-F4 in elderly patients with non-alcoholic fatty liver disease (NAFLD). Methods 110 elderly patients diagnosed with NAFLD at the 904th Hospital of the Joint Logistics Support Force from January 2022 to October 2025 were selected. Based on the LSM values detected by FibroScan, the patients were divided into F0~F2 stage group (no moderate fibrosis) and F3~F4 stage group (significant fibrosis). Compare two sets of clinical data and screen independent risk factors for progression to liver fibrosis stages F3~F4 through multiple logistic regression analysis. Results The proportion of patients combined with diabetes mellitus was significantly higher in the F3~F4 group than in the F0~F2 group (59.52% vs. 32.35%). Additionally, waist circumference (97.63±8.51 cm vs. 92.10±7.92 cm), BMI (28.02±3.25 kg/m² vs. 26.11±2.84 kg/m²), fasting blood glucose (7.55±1.83 mmol/L vs. 6.23±1.34 mmol/L), glycosylated hemoglobin (6.93%±1.22% vs. 6.10%±0.82%), triglycerides (2.40±0.72 mmol/L vs. 1.81±0.56 mmol/L), alanine aminotransferase (ALT) (55.26±17.95 U/L vs. 38.45±12.28 U/L), aspartate aminotransferase (AST) (48.56±15.24 U/L vs. 30.22±10.07 U/L), gamma-glutamyl transferase (85.42±24.53 U/L vs. 50.76±18.18 U/L), fibrosis-4 index (FIB-4) (3.62±1.04 vs. 1.90±0.53), blood urea nitrogen (6.30±1.79 mmol/L vs. 5.44±1.36 mmol/L), controlled attenuation parameter (310.42±44.57 dB/m vs. 285.35±38.71 dB/m), and the uric acid to high-density lipoprotein cholesterol ratio (UHR) (6.84±2.01 vs. 5.03±1.46) were all significantly higher in the F3~F4 group. Conversely, high-density lipoprotein cholesterol (1.03±0.21 mmol/L vs. 1.22±0.31 mmol/L) and maresin 1 (MaR1) (59.13±4.74 pg/mL vs. 77.56±5.42 pg/mL) were significantly lower in the F3~F4 group. All differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the combination of diabetes, elevated AST, high FIB-4, low MaR1 level and high UHR were independent risk factors for elderly NAFLD patients to progress to phase F3 to F4 of liver fibrosis (P<0.05). ROC curve analysis showed that the AUC values of AST, FIB-4, MaR1, and UHR for predicting the progression of liver fibrosis in elderly NAFLD patients to stages F3~F4 were 0.773, 0.787, 0.818, and 0.743, respectively. By combining the four factors to construct a predictive factor, the AUC was increased to 0.880. Conclusion The combination of diabetes, elevated AST, elevated FIB-4, decreased MaR1, and elevated UHR are independent risk factors for the progression of elderly NAFLD patients to phase F3 to F4 of liver fibrosis. The combination of AST, FIB-4, MaR1, and UHR can significantly improve the prediction efficiency.

Key words: Non-alcoholic fatty liver disease, Elderly population, Liver fibrosis, Risk factor

MIAO Rui-tian, LIU Min, ZHOU Yun, LIU Chun-fang. Observation of risk factors for the progression of significant liver fibrosis F3~F4 in elderly patients with non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2026, 31(5): 687-692.

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