Introduction & Objective: T2D in NAFLD is associated with adverse outcomes. FIB-4 score identifies high-risk NAFLD. The association of FIB-4 with mortality among NAFLD with T2D was assessed.
Methods: NHANES III-linked mortality data were used. NAFLD is defined by ultrasound without other causes of liver disease. Low risk FIB-4: <1.30 age <65/2.0 age≥65; high-risk FIB-4 ≥ 2.67.
Results: There were 738 patients with NAFLD and T2D (mean age, 58.6 [11.0] years; 41.3% male; 55.8% obesity). Compared to non-obese NAFLD+T2D, obese NAFLD+T2D were younger (57.5 vs. 60.0 years), female (64.1% vs. 51.8%) with higher hyperlipidemia rates (91.3% vs. 84.4%). No difference in 10-year cumulative mortality by obesity (obese 21.1% vs. non-obese 26.7%, p=0.077). Proportion of low, intermediate, and high-risk groups (obese 79.0%, 17.5%, 3.5% vs. non-obese 82.2%, 14.0%, 3.7%, p-values>0.20). FIB-4 area under the ROC for 10-year mortality was 0.68 [0.62-0.73]) for non-obese NAFLD+T2D and 0.61 [0.56-0.66] for obese NAFLD+T2D. Compared to non-obese NAFLD+T2D, FIB-4 had lower predictive ability for mortality for obese NAFLD+T2D. Per Youden index, lower FIB-4 threshold of 0.92 provided better 10-year mortality risk in both obese and nonobese NAFLD+T2D.
Conclusion: Presence of obesity among NAFLD+T2D negatively impacts FIB-4 performance. Lower FIB-4 threshold improves the predictive value of FIB-4 in both obese and non-obese NAFLD+T2D.
J.M. Paik: None. P. Golabi: None. M. Meneses: None. P. Macedo: None. L. Henry: None. Z. Younossi: Consultant; Gilead Sciences, Inc., Bainan Biotech, AbbVie Inc., Bristol-Myers Squibb Company, Abbott, Novo Nordisk, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Siemens Healthcare Diagnostics, Intercept Pharmaceuticals, Inc.
