丙氨酸氨基转移酶(ALT)长期以来一直是慢性肝病(CL)诊断评估的提示指标，但纤维化-4指数(FIB-4)是一种血清学评分，用于预测CL中晚期纤维化风险，可能提供一种替代信号。在调整潜在混杂因素的情况下，比较FIB-4和ALT对重度肝病(SLD)事件的预测性能。 回顾性队列研究，采用2012年至2021年的基础保健电子健康记录数据。包括至少有两组ALT和计算两个独特FIB-4得分所需的其他实验室值的成年初级保健患者，排除那些在指数FIB-4值之前就已有SLD的患者。SLD事件(肝硬化、肝细胞癌和肝移植的组合)是感兴趣的结局。ALT升高和FIB-4晚期纤维化风险的分类是主要预测变量。发展多变量 logistic 回归模型以评估FIB-4和ALT与SLD的关联，并比较每个模型的曲线下面积(AUC)。 共有20,828名患者的队列中，有14%的人的指数ALT异常(≥40 IU/L)，有8%的人的高风险指数FIB-4(≥2.67)。在研究期间，有667(3%)名患者遭受了SLD事件。经调整的多变量 logistic 回归模型显示高风险FIB-4(OR 19.34; 95%CI 15.50-24.13)、持续高风险FIB-4(OR 23.85; 95%CI 18.24-31.17)、异常ALT(OR 7.07; 95%CI 5.81-8.59)和持续异常ALT(OR 7.58; 95%CI 5.97-9.62)与SLD结局有关。指数FIB-4(0.847, p < 0.001)和组合FIB-4(0.849, p < 0.001)调整模型的AUC均超过指数ALT调整模型(0.815)。 高风险的FIB-4得分在预测未来SLD结局方面表现优于异常ALT。©2023年作者，独家授权给全科内科学会。

Alanine aminotransferase (ALT) has long provided a cue for chronic liver disease (CLD) diagnostic evaluation, but the Fibrosis-4 Index (FIB-4), a serologic score used for predicting advanced fibrosis risk in CLD, may provide an alternative signal.Compare the predictive performance of FIB-4 with ALT for severe liver disease (SLD) events while adjusting for potential confounders.Retrospective cohort study of primary care electronic health record data from 2012 to 2021.Adult primary care patients with at least two sets of ALT and other lab values necessary for calculating two unique FIB-4 scores, excluding those patients with an SLD prior to their index FIB-4 value.The occurrence of an SLD event, a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation, was the outcome of interest. Categories of ALT elevation and FIB-4 advanced fibrosis risk were the primary predictor variables. Multivariable logistic regression models were developed to evaluate the association of FIB-4 and ALT with SLD, and the areas under the curve (AUC) for each model were compared.The cohort of 20,828 patients included 14% with an abnormal index ALT (≥40 IU/L) and 8% with a high-risk index FIB-4 (≥2.67). During the study period, 667 (3%) patients suffered an SLD event. Adjusted multivariable logistic regression models demonstrated an association between high-risk FIB-4 (OR 19.34; 95%CI 15.50-24.13), persistently high-risk FIB-4 (OR 23.85; 95%CI 18.24-31.17), abnormal ALT (OR 7.07; 95%CI 5.81-8.59), and persistently abnormal ALT (OR 7.58; 95%CI 5.97-9.62) with SLD outcomes. The AUC of the index FIB-4 (0.847, p < 0.001) and combined FIB-4 (0.849, p < 0.001) adjusted models exceeded the index ALT adjusted model (0.815).High-risk FIB-4 scores demonstrated superior performance compared to abnormal ALT in predicting future SLD outcomes.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.