Endocrinol Metab.  2021 Feb;36(1):134-145. 10.3803/EnM.2020.887.

Development of a Non-Invasive Liver Fibrosis Score Based on Transient Elastography for Risk Stratification in Patients with Type 2 Diabetes

• Lee CH
• Seto WK
• Ieong K
• Lui DT
• Fong CH
• Wan HY
• Chow WS
• Woo YC
• Yuen MF
• Lam KS

• KMID: 2513297
• DOI: http://doi.org/10.3803/EnM.2020.887

Abstract

Background
In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available.
Methods
Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV).
Results
DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively.
Conclusion
Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.

Keyword

Diabetes mellitus, type 2; Non-alcoholic fatty liver disease; Elasticity imaging techniques; Fibrosis; Risk assessment

Figure

• 

  Fig. 1 Receiver operating characteristic curves of diabetes fibrosis score and conventional fibrosis scores for the identification of ≥F3 fibrosis on transient elastography in study participants of the (A) training and (B) testing sets. Data shown were area under the receiver operating characteristic curve of each non-invasive fibrosis score with 95% confidence interval in parentheses. DFS was used as referent for comparison with each conventional non-invasive fibrosis score. DFS, diabetes fibrosis score; APRI, aspartate aminotransferase-to-platelet ratio index; FIB-4, fibrosis-4; NFS, non-alcoholic fatty liver disease (NAFLD) fibrosis score. aP<0.001; bP<0.05.

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