Abbreviations
- Fibrosis‐4
FIB‐4
- M2BPGi
Mac‐2‐binding protein glycosylation isomer
We enjoyed the recent excellent article presented by Nakamura et al. [1], describing Fibrosis‐4 (FIB‐4) index was associated with severe complications and endogenous organ failure. Patients with FIB‐4 (≥ 5.0) for an increased trend in complication risk. The high FIB‐4 index group showed a higher frequency of severe complications, endogenous organ failure.
We agree that portal hypertension with liver fibrosis indicated by increased FIB‐4 index indicating increased portal hypertension with increased visceral blood congestion could impact on insufficient and imbalanced systemic organ inflow supplies. In the recent years, however, several other parameters for liver fibrosis with possible portal hypertension indicating hepatic fibrosis have been already used, including M2BPGi (Mac‐2‐binding protein glycosylation isomer) [2], hyaluronic acid, type IV collagen, and platelet count [3]. On the other hand, other tests, including ALBI (Albumin–Bilirubin) grade and indocyanine green, are for evaluating hepatocyte functions. Thus, we recognize that evaluation of liver fibrosis indicating portal hypertension and hepatocyte function possible developing liver failure has different aspects.
The very interesting points in the article by Nakamura et al. [1] are advanced liver fibrosis as indicated by an advanced FIB‐4 index, systemically effected by post‐hepatectomy systemic functions, possibly caused by decreased clearance of intestinal barrier function and impaired clearance of inflammatory mediators, and possibly due to congested visceral circulatory congestion. However, the weak point of the article by Nakamura et al. [1] is that they did not compare other hepatic fibrosis indexes including M2BPGi, type IV collagen, and platelet count, all of which we routinely use in daily practices.
Thus, we would friendly like to ask them to compare the other parameters including FIB‐4 index, M2BPGi, hyaluronic acid, type IV collagen, and platelet count using receiver operating characteristic curve, or explain the reasons they only evaluated FIB‐4 index for post‐hepatectomy as the primary end‐point.
Author Contributions
Toru Ikegami: conceptualization, project administration, writing – original draft. Hiroshi Nakanishi: writing – review and editing. Kanako Maeda: writing – review and editing. Kenei Furukawa: conceptualization.
Funding
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
References
- 1. Nakamura M., Okamura Y., Aramaki O., et al., “Preoperative FIB‐4 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma,” Annals of Gastroenterological Surgery (2026), 10.1002/ags3.70263. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.