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

Endocrinology and Metabolism

卷:36

Wai-Kay Seto¹  Kelly Ieong¹  Carol H.Y. Fong¹  Karen S.L. Lam¹  Yu-Cho Woo¹  David T.W. Lui¹  Chi-Ho Lee¹  Man-Fung Yuen¹  Helen Y. Wan¹  Wing-Sun Chow¹ 

[1] Department of Medicine, University of Hong Kong, Hong Kong, China;

关键词: diabetes mellitus;    type 2;    non-alcoholic fatty liver disease;    elasticity imaging techniques;    fibrosis;    risk assessment;   

DOI  :  10.3803/EnM.2020.887

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown