NON-ALCOHOLIC FATTY LIVER DISEASE FIBROSIS SCORES AS PREDICTORS OF DISEASE PROGRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE COHORT STUDY AT KING HUSSEIN MEDICAL CENTER

Abstract

Background: Inflammatory Bowel Disease (IBD) is associated with various hepatic manifestations, with non-alcoholic fatty liver disease (NAFLD) being the most common. Non-invasive fibrosis scores (FIB-4, NFS) are validated tools for risk-stratifying NAFLD patients. Whether these scores predict IBD clinical progression remains unknown. Aims: This study aimed to evaluate whether baseline non-invasive liver fibrosis scores (FIB-4 and NFS) can predict clinical disease progression in an IBD cohort. Methods: A retrospective longitudinal cohort study included 266 adult patients with confirmed Crohn's disease or Ulcerative colitis followed at King Hussein Medical Center for a minimum of 2 years (January 2022 – January 2024). Baseline FIB-4 and NFS were calculated and patients categorized into low-risk versus intermediate/high-risk fibrosis groups. Primary outcome was a composite of IBD progression: IBD-related hospitalization, systemic corticosteroid requirement, escalation to biologic therapy, or new intestinal complication. Time-to-event analysis used Kaplan-Meier and Cox proportional hazards models adjusting for traditional IBD risk factors. Results: Among 266 patients (mean age 42.3 ± 14.8 years, 54.1% male), 62.4% had Ulcerative colitis and 37.6% Crohn's disease. Elevated fibrosis risk (intermediate/high FIB-4) was present in 28.2%. Over 2-year follow-up, 102 patients (38.3%) experienced IBD progression. Patients with elevated fibrosis risk had significantly higher progression rates (58.7% vs. 30.4%, p<0.001). On multivariate Cox regression, elevated FIB-4 (HR=2.45, 95% CI: 1.62–3.71) and elevated NFS (HR=2.18, 95% CI: 1.45–3.28) were independent predictors of IBD progression after adjusting for age, sex, disease duration, and baseline therapy. Conclusion: Non-invasive liver fibrosis scores, particularly FIB-4, are independent predictors of disease progression in IBD patients. These easily calculated scores may serve as valuable prognostic tools for risk stratification in routine IBD management.