Liver and Nonliver-Related Outcomes at 2 Years Are Not Influenced by the Results of the FIB-4 Test and Liver Elastography in a Real-Life Cohort of Patients with Type 2 Diabetes

Abstract

Aims. To investigate morbidity and mortality in a real-life cohort of patients with type 2 diabetes (T2D) in relation to prevalence and severity of nonalcoholic fatty liver disease (NAFLD). Methods. Patients with T2D were referred for assessment of liver fibrosis by the FIB-4 test and liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE). Liver steatosis was quantified by the controlled attenuation parameter (CAP). These patients were followed until death or censored date. Results. Among 454 patients (52% males, mean age 62.5 years, BMI 30.9 kg/m2), 82.6% was overweight, 77.8% had fatty liver, and 9.9% and 3.1% had LSM and FIB-4 values suggestive of advanced fibrosis, respectively. During the follow-up period of median 2 years, 106 (23%) patients experienced adverse event (11% cardiovascular) and 17 (3.7%) died, whereas no liver-related morbidity or mortality was observed. Independent predictors of adverse outcomes were age and higher platelet count, while FIB-4, LSM, and CAP were not. Conclusion. In a cohort of T2D patients, no liver-related morbidity or mortality occurred during 2 years. Our patients probably have low real prevalence of advanced fibrosis which is likely overestimated by LSM ≥ 9.6 kPa. Liver fibrosis may be safely reassessed in the 2 years interval in noncirrhotic patients with T2D.

Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study

“…The median follow-up was only 2 years, and the primary outcome, all-cause mortality, occurred only in 3.7% of the individuals; and the secondary outcome, which occurred in 23%, included a composite of several non liver-related morbidity outcomes. Different from our findings, they did not find any associations between TE parameters and the outcomes [ 20 ]. However, similar to our findings, in this study the subgroup with more severe steatosis had the lowest incidence of adverse outcomes [ 20 ].…”

“…Different from our findings, they did not find any associations between TE parameters and the outcomes [ 20 ]. However, similar to our findings, in this study the subgroup with more severe steatosis had the lowest incidence of adverse outcomes [ 20 ]. In the present study, we followed the patients for a longer time than these studies (median of 5.5 years), and we had a greater number of events than the studies from Liu et al [ 18 ] and Grgurevic et al [ 20 ], which allowed us to analyze separately total CVEs, MACEs, and cardiovascular and all-cause mortality.…”

“…Although TE has been well-validated to assess the extent of liver fibrosis and steatosis in NAFLD [ 12 – 16 ], data about LSM and CAP for prediction of events in NAFLD are scarce [ 17 – 20 ]. In a retrospective analysis of consecutive individuals with NAFLD, with a median follow-up of 35 months, LSM at baseline and its changes during follow-up predicted liver-related outcomes and all-cause mortality [ 17 ].…”

“…Another study with 1120 type 2 diabetic patients [ 30 ] reported that only the subgroup with liver fibrosis, defined by the FIB-4, a non-invasive laboratorial score, had progressive carotid intima-media thickening over a median follow-up of 6–8 years. However, only one previous study investigated LSM and CAP usefulness in risk stratification for cardiovascular morbidity and mortality and all-cause mortality in 454 individuals with type 2 diabetes [ 20 ]. Nonetheless, this study had several limitations that precluded a comprehensive analysis.…”

“…Similarly, the controlled attenuation parameter (CAP), also obtained by TE, is feasible to screen and quantify liver steatosis, but with lower sensitivity and specificity [ 14 – 16 ]. However, there are scarce longitudinal data that investigated whether LSM and CAP are associated with clinical outcomes in NAFLD [ 17 – 19 ], particularly in diabetic individuals [ 20 ].…”