Objective: In NAFLD, non-invasive serum-based fibrosis scores are often recommended as first-line assessment tools, followed by transient elastography to identify patients at high risk of liver fibrosis for consideration of liver biopsy. However, some studies had reported lower accuracy of these scores in diabetes. Therefore, we conducted this cross-sectional study to develop a non-invasive fibrosis score specifically for type 2 diabetes to improve risk stratification.
Research Design and Methods: A total of 815 adults with type 2 diabetes and NAFLD was recruited from the diabetes clinic in Hong Kong. A random sample of 643 individuals were included in the training set, and the remaining 172 in the testing set. All participants had transient elastography for assessment of liver fibrosis. Diabetes Fibrosis Score (DFS) was developed to identify patients with advanced fibrosis (AF) on transient elastography, defined as liver stiffness (LS) >9.5kPa, using significant determinants of LS with variables selected based on Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NAFLD fibrosis score [NFS], Fib-4 and APRI), based on their area under the receiver operating characteristic (AUROC) curve, sensitivity (Sn), specificity (Sp), positive (PPV) and negative predictive values (NPV).
Results: The variables included in DFS consisted of body mass index, platelet, alanine and aspartate aminotransferase levels. The AUROC of DFS for AF on transient elastography was 0.822, while those of NFS, APRI and Fib-4 were 0.629, 0.643 and 0.788, respectively. In the testing set, the AUROC of DFS was 0.852, with 76.7% Sn, 82.3% Sp, PPV 48.2% and NPV 94.3%.
Conclusions: Compared to conventional non-invasive fibrosis scores, DFS more accurately identified, amongst patients comorbid with type 2 diabetes and NAFLD, those who should undergo transient elastography to evaluate their risk of liver fibrosis.
C. Lee: None. W. Seto: None. K. Ieong: None. D.T.W. Lui: None. H. Fong: None. H. Wan: None. W. Chow: None. Y. Woo: None. M. Yuen: None. K.S. Lam: Advisory Panel; Self; Merck Sharp & Dohme Corp.