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

Endocrinology and Metabolism 2021년 36권 1호 p.134 ~ 145
Lee Chi-Ho, Seto Wai-Kay, Ieong Kelly, Lui David T. W., Fong Carol H. Y., Wan Helen Y., Chow Wing-Sun, Woo Yu-Cho, Yuen Man-Fung, Lam Karen S. L.,
소속 상세정보
 ( Lee Chi-Ho ) - University of Hong Kong Department of Medicine
 ( Seto Wai-Kay ) - University of Hong Kong Department of Medicine
 ( Ieong Kelly ) - University of Hong Kong Department of Medicine
 ( Lui David T. W. ) - University of Hong Kong Department of Medicine
 ( Fong Carol H. Y. ) - University of Hong Kong Department of Medicine
 ( Wan Helen Y. ) - University of Hong Kong Department of Medicine
 ( Chow Wing-Sun ) - University of Hong Kong Department of Medicine
 ( Woo Yu-Cho ) - University of Hong Kong Department of Medicine
 ( Yuen Man-Fung ) - University of Hong Kong Department of Medicine
 ( Lam Karen S. L. ) - University of Hong Kong Department of Medicine

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.

키워드

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

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