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Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease

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Abstract

Background/aim

Simple noninvasive fibrosis scores based on routine blood tests have been increasingly investigated as screening tools in different clinical settings. Here, we sought to examine whether the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) could perform differently in diabetic versus non-diabetic patients with biopsy-proven NAFLD.

Methods

We examined 349 patients with biopsy-proven NAFLD (166 with type 2 diabetes and 183 without). Patients with FIB-4 scores < 1.3 and  > 2.67 or NFS scores < − 1.455 and  > 0.676 were considered at low and high risk of advanced fibrosis, respectively.

Results

A FIB-4 cutoff value of 1.3—which denotes a low risk of advanced fibrosis—had a specificity of 67% in patients with diabetes and 69% in those without. Conversely, a FIB-4 cutoff value of 2.67—which denotes a high risk of advanced fibrosis—had a sensitivity of 22% in patients with diabetes and 0% in those without. NFS performed similar to FIB-4.

Conclusion

Both FIB-4 and NFS scores have an acceptable clinical utility in the exclusion of advanced fibrosis in patients with NAFLD, regardless of the presence of type 2 diabetes. However, their usefulness in identifying advanced fibrosis is limited—especially in the absence of diabetes.

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References

  1. Chalasani N, Younossi Z, Lavine JE, et al. (2018) The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 67:328–357

    Article  Google Scholar 

  2. Kaya E, Yılmaz Y (2019) Non-alcoholic fatty liver disease: a growing public health problem in Turkey. Turk J Gastroenterol. https://doi.org/10.5152/tjg.2019.18045

    Article  PubMed  PubMed Central  Google Scholar 

  3. Younossi Z, Tacke F, Arrese M, et al. (2019) Global perspectives on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Hepatology 69:2672–2682

    Article  Google Scholar 

  4. Dai W, Ye L, Liu A, et al. (2017) Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis. Medicine (Baltimore) 96:e8179

    Article  Google Scholar 

  5. Tada T, Toyoda H, Sone Y, et al. (2019) Type 2 diabetes mellitus: a risk factor for progression of liver fibrosis in middle-aged patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. https://doi.org/10.1111/jgh.14734

    Article  PubMed  Google Scholar 

  6. Li Q, Dhyani M, Grajo JR, et al. (2018) Current status of imaging in nonalcoholic fatty liver disease. World J Hepatol 10:530–542

    Article  Google Scholar 

  7. Stål P (2015) Liver fibrosis in non-alcoholic fatty liver disease - diagnostic challenge with prognostic significance. World J Gastroenterol 21:11077–11087

    Article  Google Scholar 

  8. Morling JR, Fallowfield JA, Guha IN, et al. (2014) Edinburgh type 2 diabetes study investigators. Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: the Edinburgh type 2 diabetes study. J Hepatol 60:384–391

    Article  CAS  Google Scholar 

  9. Sanyal AJ, Brunt EM, Kleiner DE, et al. (2011) Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology 54:344–353

    Article  Google Scholar 

  10. American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62–S69

    Article  Google Scholar 

  11. Swarup S, Zeltser R (2019) Metabolic syndrome. StatPearls. The US National Library of Medicine; [updated 2019 Feb 28; cited 2019 May 28]. www.ncbi.nlm.nih.gov/books/NBK459248/

  12. Shah AG, Lydecker A, Murray K, et al. (2009) Nash clinical research network. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 7:1104–1112

    Article  CAS  Google Scholar 

  13. Angulo P, Hui JM, Marchesini G, et al. (2007) The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 45:846–854

    Article  CAS  Google Scholar 

  14. Bedossa P, Poitou C, Veyrie N, et al. (2012) Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology 56:1751–1759

    Article  Google Scholar 

  15. Kleiner DE, Brunt EM, Van Natta M, et al. (2005) Nonalcoholic steatohepatitis clinical research network. Nonalcoholic steatohepatitis clinical research network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321

    Article  Google Scholar 

  16. Richards JA (2013) Remote sensing digital image analysis: an introduction, 5th edn. Springer, Berlin

  17. Guha IN, Parkes J, Roderick P, et al. (2008) Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: validating the European Liver Fibrosis Panel and exploring simple markers. Hepatology 47:455–460

    Article  Google Scholar 

  18. McPherson S, Anstee QM, Henderson E, et al. (2013) Are simple noninvasive scoring systems for fibrosis reliable in patients with NAFLD and normal ALT levels? Eur J Gastroenterol Hepatol 25:652–658

    Article  Google Scholar 

  19. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016;64:1388–402.

  20. Angulo P, Kleiner DE, Dam-Larsen S, et al. (2015) Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 149:389–397

    Article  Google Scholar 

  21. Ekstedt M, Hagström H, Nasr P, et al. (2015) Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology 61:1547–1554

    Article  CAS  Google Scholar 

  22. Singh S, Allen AM, Wang Z, et al. (2015) Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol 13:643–654

    Article  Google Scholar 

  23. Alkhouri N, Lawitz E, Noureddin M (2019) Looking into the crystal ball: predicting the future challenges of fibrotic NASH treatment. Hepatol Commun 3:605–613

    Article  Google Scholar 

  24. Cheah MC, McCullough AJ, Goh GB (2017) Current modalities of fibrosis assessment in non-alcoholic fatty liver disease. J Clin Transl Hepatol 5:261–271

    PubMed  PubMed Central  Google Scholar 

  25. Friedrich-Rust M, Ong MF, Martens S, et al. (2008) Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 134:960–974

    Article  Google Scholar 

  26. Wong VW, Vergniol J, Wong GL, et al. (2010) Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology 51:454–462

    Article  CAS  Google Scholar 

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, Marmara University, Istanbul, Turkey

    Tasnim Alkayyali & Lubna Qutranji

  2. Institute of Gastroenterology, Marmara University, Istanbul, Turkey

    Eda Kaya & Yusuf Yilmaz

  3. Department of Biostatistics and Medical Informatics, School of Medicine, Halic University, Istanbul, Turkey

    Alev Bakir

  4. Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey

    Yusuf Yilmaz

Authors
  1. Tasnim Alkayyali
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  2. Lubna Qutranji
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  3. Eda Kaya
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  4. Alev Bakir
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  5. Yusuf Yilmaz
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Contributions

All authors contributed to the study conception and design. Tasnim Alkayyali, Lubna Qutranji, Eda Kaya, and Alev Bakir contributed to data collection and analysis. Tasnim Alkayyali, Lubna Qutranji, and Eda Kaya took part in manuscript drafting. Yusuf Yilmaz involved in study design and supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yusuf Yilmaz.

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None declared.

Ethical standard

The study followed the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of the Faculty of Medicine, Marmara University (Istanbul, Turkey).

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Alkayyali, T., Qutranji, L., Kaya, E. et al. Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease. Acta Diabetol 57, 613–618 (2020). https://doi.org/10.1007/s00592-019-01467-7

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  • DOI: https://doi.org/10.1007/s00592-019-01467-7

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