Importance of non-invasive liver fibrosis scores for mortality and complications development in individuals with type 2 diabetes

Leite, Nathalie C.; Cardoso, Claudia R.L.; Salles, Gil F.

doi:10.1016/j.jdiacomp.2021.107879

Cited by 13 publications

(15 citation statements)

References 45 publications

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“…The literature search identified 2613 papers, after duplication removal. After abstract evaluations, 16 studies were considered for the full text analysis [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (Figure 1). Three studies have been excluded, since one is a duplication of previously published results [45], and two works did not report the prevalence of neuropathy in NAFLD positive and negative patients [43,44] (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Greco

Nascimbeni

Carubbi

et al. 2021

JCM

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Aims. The relationship between nonalcoholic fatty liver disease (NAFLD) and diabetic polyneuropathy (DPN) has been demonstrated in many studies, although results were conflicting. This meta-analysis aims to summarize available data and to estimate the DPN risk among NAFLD patients. Materials and methods. We performed a comprehensive literature review until 4 June 2021. Clinical trials analyzing the association between NAFLD and DPN were included. Results. Thirteen studies (9614 participants) were included. DPN prevalence was significantly higher in patients with NALFD, compared to patients without NAFLD (OR (95%CI) 2.48 (1.42–4.34), p = 0.001; I2 96%). This finding was confirmed in type 2 diabetes (OR (95%CI) 2.51 (1.33–4.74), p = 0.005; I2 97%), but not in type 1 diabetes (OR (95%CI) 2.44 (0.85–6.99), p = 0.100; I2 77%). Also, body mass index and diabetes duration were higher in NAFLD subjects compared to those without NAFLD (p < 0.001), considering both type 2 and type 1 diabetes. Conclusion. Despite a high heterogeneity among studies, a significantly increased DPN prevalence among type 2 diabetes subjects with NAFLD was observed. This result was not found in type 1 diabetes, probably due to the longer duration of disease. Physicians should pay more attention to the early detection of DPN, especially in patients with NAFLD.

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Section: Resultsmentioning

confidence: 99%

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Greco

Nascimbeni

Carubbi

et al. 2021

JCM

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“…Patients grouped at high risk by either NFS or FIB‐4 had higher placebo incidence rates of cardiovascular outcomes and all‐cause mortality. While this observation may be expected, as age and/or serum albumin levels are included in the formulas, 22 several publications suggest that FIB‐4 and/or NFS might be useful predictors of all‐cause mortality in NAFLD with and without type 2 diabetes and thus help to improve risk stratification 23‐26 . However, the relationship between risk scores and cardiorenal outcomes remains somewhat puzzling.…”

Section: Discussionmentioning

confidence: 99%

“…While this observation may be expected, as age and/or serum albumin levels are included in the formulas, 22 several publications suggest that FIB-4 and/or NFS might be useful predictors of all-cause mortality in NAFLD with and without type 2 diabetes and thus help to improve risk stratification. [23][24][25][26] However, the relationship between risk scores and cardiorenal outcomes remains somewhat puzzling. Data from several cohorts as well as the present data show an association of FIB-4…”

Section: Discussionmentioning

confidence: 99%

Effects of empagliflozin on markers of liver steatosis and fibrosis and their relationship to cardiorenal outcomes

Kahl

Ofstad

Zinman

et al. 2022

Diabetes Obesity Metabolism

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Aims: Empagliflozin treatment reduced liver fat in small type 2 diabetes cohorts. This post-hoc study evaluated effects of empagliflozin on risk for non-alcoholic fatty liver disease-related steatosis and fibrosis, as well as the relationship between risk categories and cardiorenal outcomes in the randomized, placebo-controlled EMPA-REG OUTCOME trial. Materials and methods: EMPA-REG OUTCOME treated 7020 people with type 2 diabetes and cardiovascular disease with 10/25 mg/day empagliflozin or placebo. For this analysis, the Dallas steatosis index, hepatic steatosis index, non-alcoholic fatty liver disease fibrosis score and Fibrosis-4 score were calculated to assess steatosis and fibrosis risk. Changes from baseline in scores were examined by mixed model repeated measures and their associations with cardiorenal outcomes and mortality by Cox regression. Results: At baseline, 73% and 84% of participants had high steatosis risk by Dallas steatosis index and hepatic steatosis index, whereas 23% and 4% had a high risk of advanced fibrosis by non-alcoholic fatty liver disease fibrosis score and Fibrosis-4 score. Percentages of people at high steatosis risk slightly decreased with empagliflozin only, whereas empagliflozin did not improve percentages of individuals at high fibrosis risk over time compared with placebo. The high risk of advanced fibrosis at baseline related to higher risk for cardiovascular events. Effects of empagliflozin on cardiorenal and all-cause mortality outcomes were consistent across all risk groups. Conclusions: Empagliflozin may reduce steatosis but not fibrosis risk in individuals with type 2 diabetes and cardiovascular disease. The improvements in cardiorenal outcomes and mortality associated with empagliflozin therapy appear to be independent of steatosis and fibrosis risk.

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“…For this specific investigation, the patients with liver cirrhosis or other potential causes of liver diseases (i.e., viral hepatitis, autoimmune hepatitis, hereditary liver disease, secondary causes of fatty liver, and drug-induced liver disease) were excluded ( 17 , 24 , 25 ). The participants with excessive alcohol consumption (>21 drinks/week in men and >14 drinks/week in women) were also excluded ( 17 , 25 , 26 ). The retrospective study was approved by the Ethics Committee in Clinical Research (ECCR) of the authors' hospitals, and the requirement for informed consent was waived.…”

Section: Methodsmentioning

confidence: 99%

Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma

et al. 2022

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ObjectiveAlthough liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence.MethodsWe retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH.ResultsA total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results.ConclusionsThe data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.

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Importance of non-invasive liver fibrosis scores for mortality and complications development in individuals with type 2 diabetes

Cited by 13 publications

References 45 publications

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Effects of empagliflozin on markers of liver steatosis and fibrosis and their relationship to cardiorenal outcomes

Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma

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