Accuracy of Noninvasive Fibrosis Scores to Detect Advanced Fibrosis in Patients With Type-2 Diabetes With Biopsy-proven Nonalcoholic Fatty Liver Disease

Singh, Amandeep; Gosai, Falgun; Siddiqui, Mohamed Tausif; Gupta, Mohit; López, Rocío; Lawitz, Eric; Poordad, Fred; Carey, William; McCullough, Arthur J.; Alkhouri, Naim

doi:10.1097/mcg.0000000000001339

Cited by 31 publications

(36 citation statements)

References 31 publications

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“…The FIB‐4, NFS, and aspartate aminotransferase (AST)‐to‐platelet ratio index (APRI) were chosen as the diagnostic panels to identify participants with advanced fibrosis, as these are well validated, supported by the literature (9,10,27‐29,31,37,38), and most widely used in clinical practice. NFS, FIB‐4, and APRI were calculated as follows:

F I B ‐ 4 = Age ()(, years) \times AST ()(, normalU false/ normalL) false/ Platelet ()(, \times 10^{9} /L) \times \sqrt{ALT} ()(, normalU false/ normalL)

…”

Section: Methodsmentioning

confidence: 99%

Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease

Barb

Repetto

Stokes³

et al. 2021

Obesity

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Objective This study assessed the impact of diabetes mellitus (DM) on nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) with advanced fibrosis prevalence in adults with overweight or obesity in the United States. Methods Participants (National Health and Nutrition Examination Survey [NHANES] 2015‐2016 database) included 834 middle‐aged patients with DM (21.7%) and 3,007 without DM (78.3%). NAFLD was defined by Fatty Liver Index (FLI) ≥ 60 or United States FLI (USFLI) ≥ 30. Moderate‐to‐high and high risk of advanced fibrosis was defined by fibrosis‐4 index (FIB‐4) ≥ 1.67 and ≥ 2.67, respectively, and NAFLD fibrosis scores > 0.676 also indicated a high risk. Results NAFLD prevalence increased with BMI. Steatosis was higher in individuals with overweight with DM versus without DM (USFLI ≥ 30: 48.3% vs. 17.4%; p < 0.01) and in individuals with obesity with DM versus without DM (USFLI ≥ 30: 79.9% vs. 57.6%; p < 0.01). DM significantly increased the proportion of individuals at moderate‐to‐high risk of fibrosis (FIB‐4 ≥ 1.67: 31.8% vs. 20.1%; p < 0.05). In the high risk of advanced fibrosis group (FIB‐4 ≥ 2.67), the risk almost doubled (3.8% vs. 7.1%). Among individuals with obesity, DM increased the proportion of adults with moderate and high risk of fibrosis by 1.8‐ and 2.5‐fold, respectively (p < 0.01 and p = 0.39, respectively, vs. without DM). Conclusions In this US cohort, DM modestly impacted steatosis, which was primarily obesity‐driven. DM added a significant risk of fibrosis to individuals with overweight or obesity, suggesting that screening is imperative in adults with DM.

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F I B ‐ 4 = Age ()(, years) \times AST ()(, normalU false/ normalL) false/ Platelet ()(, \times 10^{9} /L) \times \sqrt{ALT} ()(, normalU false/ normalL)

…”

Section: Methodsmentioning

confidence: 99%

Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease

Barb

Repetto

Stokes³

et al. 2021

Obesity

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“…McPherson and colleagues also suggested 2.0 of low COI in 65 years or older [ 95 ]. On data of 1008 patients with MAFLD from nine centers across eight countries (The Gut and Obesity in Asia (GOASIA) Workgroup), NITs such as APRI, NFS, and FIB-4 index had a lower specificity in elderly (AUROC 0.62–0.65) [ 97 ]. Female (OR: 3.21; 95% CI 1.37–7.54] and hypertension (OR 3.68; 95%CI 1.11–12.23) were predicting factors for advanced fibrosis in the elderly [ 97 ].…”

Section: Drawbacks Of Fib-4 Indexmentioning

confidence: 99%

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

Sumida

Yoneda

Tokushige

et al. 2021

Life

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The prevalence of obesity or metabolic syndrome is increasing worldwide (globally metabodemic). Approximately 25% of the adult general population is suffering from nonalcoholic fatty liver disease (NAFLD), which has become a serious health problem. In 2020, global experts suggested that the nomenclature of NAFLD should be updated to metabolic-dysfunction-associated fatty liver disease (MAFLD). Hepatic fibrosis is the most significant determinant of all cause- and liver -related mortality in MAFLD. The non-invasive test (NIT) is urgently required to evaluate hepatic fibrosis in MAFLD. The fibrosis-4 (FIB-4) index is the first triaging tool for excluding advanced fibrosis because of its accuracy, simplicity, and cheapness, especially for general physicians or endocrinologists, although the FIB-4 index has several drawbacks. Accumulating evidence has suggested that vibration-controlled transient elastography (VCTE) and the enhanced liver fibrosis (ELF) test may become useful as the second step after triaging by the FIB-4 index. The leading cause of mortality in MAFLD is cardiovascular disease (CVD), extrahepatic malignancy, and liver-related diseases. MAFLD often complicates chronic kidney disease (CKD), resulting in increased simultaneous liver kidney transplantation. The FIB-4 index could be a predictor of not only liver-related mortality and incident hepatocellular carcinoma, but also prevalent and incident CKD, CVD, and extrahepatic malignancy. Although NITs as milestones for evaluating treatment efficacy have never been established, the FIB-4 index is expected to reflect histological hepatic fibrosis after treatment in several longitudinal studies. We here review the role of the FIB-4 index in the management of MAFLD.

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“…These patients might be falsely classified into NASH group, which might introduce bias in logistic regression analysis. Nevertheless, several noninvasive models for predicting NASH or advanced liver fibrosis of NAFLD showed lower performance in diabetes patients than in non-diabetes patients [27,28]. Thus, the contribution of bile acid to the NASH development in diabetes patients need to further clarify.…”

Section: Discussionmentioning

confidence: 97%

Increased serum total bile acid is independently associated with non-alcoholic steatohepatitis in non-diabetes population

Li¹,

Ma²,

Gu³

et al. 2020

Preprint

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Background and aims Bile acids, which modulate the glycose and lipid metabolism, play an important role in the development of non-alcoholic fatty liver disease (NAFLD). This study aims to explore the association between serum total bile acid (TBA) and non-alcoholic steatohepatitis (NASH) in the general population from a large clinical dataset. Methods NAFLD individuals confirmed by ultrasonography were enrolled in the study. The NASH was defined as the NAFLD individual with abnormal liver function, and non-alcoholic fatty liver (NAFL) was defined as the NAFLD individual with normal liver function. The demographic characters, biochemical results including serum TBA were compared between NASH and NAFL patients. The independently associated factors with NASH were investigated by multivariate logistic regression analysis. Results A total of 6862 individuals were enrolled in the study, of which 23.7% were NASH. The median age was 45 (39-55) years old, and the BMI was 26.9(25.1-28.9) kg/m 2 . The NASH patients showed higher levels of serum TBA compared to the NAFL patients [3.30(2.30-5.0) μmol/L vs. 2.70(1.90-4.20) μmol/L, P <0.001]. The prevalence of NASH tended to increase with the increasing of serum TBA level ( P <0.001). Multivariate logistic regression analysis showed the age, male, serum TBA levels, diabetes mellitus (DM), serum uric acid, total cholesterol and triglyceride were independent risk factors for NASH ( P <0.05). Stratification analysis according to DM status showed that serum TBA was independently associated with NASH in individuals without DM (OR: 1.55, 95% CI: 1.11-2.13, P =0.008), while not in individuals with DM (OR: 1.32, 95% CI: 0.53-2.96, P =0.515). Conclusion Serum TBA level was significantly higher in NASH patients than in NAFL patients, and was independently associated with NASH in non-diabetes population.

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Accuracy of Noninvasive Fibrosis Scores to Detect Advanced Fibrosis in Patients With Type-2 Diabetes With Biopsy-proven Nonalcoholic Fatty Liver Disease

Cited by 31 publications

References 31 publications

Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease

Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

Increased serum total bile acid is independently associated with non-alcoholic steatohepatitis in non-diabetes population

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