Background: Fibrosis-4 (FIB-4) and the Nonalcoholic fatty liver disease fibrosis score (NFS) are suggested by American Diabetes Association Standard of Care 2023 for Liver fibrosis screening in type 2 diabetes (T2D).
Aim: Utility of FIB-4 and NFS to detect liver fibrosis in Asian-Indians with T2D.
Methods: This study included a total of 120 patients who underwent NAFLD screening from July 2022 to December 2022, recruited from Liver Clinic of an Endocrine speciality centre. Vibration Controlled Transient Elastography [VCTE (Fibroscan 430 Mini Plus, Echosens, France)] was used. After excluding alcoholics and nondiabetes patients we had total 73 people with T2D and we calculated FIB-4 and NFS for 46 patients. Liver Stiffness measurement (LSM) in KiloPascals (KPa) cut-off values used are - F0 till 7 kPa, F1 is 7 - 10 kPa, F2 is 10 - 13 kPa, F3 is 13 - 16 kPa and F4 is > 16 kPa. FIB-4 and NFS were calculated using https://www.mdcalc.com.
Results: The mean age was 54.6 ± 12.4 years, mean body mass index (BMI) was 27.3 ± 3.7 kg/m2 and 14 (30.4%) were women. Overweight seen in 15.2 % (n=7) and obesity in 69.6 % (n=32). The mean values, Serum Albumin (5.1±2.4 g/dl), SGOT (20.7±8.9 U/L), SGPT (24.0 ±15.1 U/L), Platelet Count (2.7±0.8 x 105) Hba1c % (8.8±2.4) and LSM (6.4 ± 2.6 KPa). NFS grades: F0-F2 in 24 (52.2%), indeterminate in 18 (39%) and F3-F4 in 4 (8.7%). FIB-4 grades: F0-F1 in 40 (86.9%) and F2-F3 in 6 (13.1%). But on VCTE as per LSM it was found F0 in 32 (70%), F1 in 9 (19.6%), F2 in 4 (8.7%) and F4 in 1 (2.2%). We noticed that LSM had significant positive correlation with BMI (p=0.001), SGOT (p=0.04) and SGPT (p=0.011) which are components of FIB-4 and NFS but LSM did not significantly correlate with NFS (p=0.96) and FIB-4 score (p=0.79).
Conclusions: FIB-4 and NFS may be sub-optimal for screening Fibrosis in Asian-Indians with T2D. BMI can be considered as potential first step to identify at risk for liver fibrosis in T2D.
K. Ravi Teja: None. S. Chandel: None.
