Visual Abstract
Background: Screening T2DM for NASH fibrosis using specific markers is mandatory, as liver enzymes are often normal despite advanced fibrosis. LIVERFASt (LF), a serum marker with CPT code for assessing liver fibrosis (LF-Fib), activity and steatosis had high performance for identifying severe NASH in T2DM.
Aim: To demonstrate that LF-Fib is an alternative to biopsy (LB) for the estimation of the transition rate to fibrosis [F1 stage or more (TRF1)], in T2DM NAFLD with better performances than transient elastography (TE) and FIB4.
Methods: TRF1 was evaluated using Cox-Mantel HazardRatios [HR(95%CI), logrank comparison] with a modeling of hazard from birth to age of LB, in prospectively collected NAFLD pts with concomitant LB and LF, TE, FIB4.
Results: N=583pts were included, 52% T2DM, 56%males, median (range) age 59.5% (18-85), HbA1c 6.6% (4.7-12), BMI 31.5 (20-54)kg/m2 (obesity 59%). The estimation of TRF1 [HR(95%CI)] using LF-Fib was similar to that of LB in both T2DM [0.67 (0.56-0.80) vs. 0.65( 0.54-0.79)], and no-T2DM [1.50 (1.26-1.78) vs. 1.54 (1.27-1.86)], respectively, with earlier TRF1 in no-T2DM (logrank p<0.0001). The performance for estimating TRF1 was less fit to that of LB in both T2DM and no-T2DM groups for TE and FIB4 (Figure)
Conclusion: Validated biomarkers such as LIVERFASt should allow a powerful analysis of fibrosis progression in T2DM similar to LB and better screening strategies for stratifying T2DM.
V. Deledinghen: None. M. Munteanu: Consultant; Self; Fibronostics. I. Alam: Advisory Panel; Self; Fibronostics. A. Delamarre: None. B. Lebail: None. H. Marraud-des-grottes: None. M. Irlès-depé: None. M. Decraecker: None. J. Foucher: None. J. Hiriart: None. R. Quiambao: Employee; Self; Fibronostics.
