Non-invasive liver fibrosis scores and mortality in a cohort of World Trade Center rescue/recovery workers

21/11/2025

BMJ Open Gastroenterol. 2025 Nov 19;12(1):e001889. doi: 10.1136/bmjgast-2025-001889.

ABSTRACT

OBJECTIVES: Higher liver fibrosis scores have been associated with 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 and liver cancer incidence in an occupational cohort.

METHODS: The study included 43 870 Combined World Trade Center Rescue/Recovery Worker Cohort members who had blood drawn between 11/9/2001-31/12/2020. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 score (FIB-4), and non-alcoholic fatty liver disease fibrosis score (NFS) were calculated and categorised as low, intermediate or high scores per established cut-offs. Deaths and liver cancers were identified via National Death Index records and state cancer registries. Cox proportional hazards regression models estimated HRs and 95% CIs for each outcome in those with intermediate and high versus low fibrosis scores.

RESULTS: By 31/12/2020, 1996 deaths, 81 liver disease-related deaths and 36 incident liver cancers occurred. Participants with intermediate or high APRI (HR=1.73, 95% CI 1.50 to 1.99 and HR=7.23, 95% CI 5.63 to 9.29), FIB-4 (HR=1.18, 95% CI 1.05 to 1.34 and HR=3.96, 95% CI 3.22 to 4.85) or NFS (HR=1.61, 95% CI 1.43 to 1.81 and HR=4.73, 95% CI 3.78 to 5.93) had increased risks of all-cause mortality vs those with low scores, controlling for potential confounders. Those with intermediate/high scores also had increased liver disease- and non-liver disease-related mortality. High APRI, FIB-4 and NFS, and intermediate APRI and NFS were associated with liver cancer.

CONCLUSIONS: 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 this population. Liver fibrosis scores may identify those at greater risk for poor health outcomes, even in a healthy occupational cohort.

PMID:41265935 | DOI:10.1136/bmjgast-2025-001889

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