Low accuracy of FIB-4 test to identify people with diabetes at low risk of advanced fibrosis

Gracen, Lucy; Hayward, Kelly L.; Irvine, Katharine M.; Valery, Patricia C.; Powell, Elizabeth E.

doi:10.1016/j.jhep.2022.06.016

Cited by 13 publications

(10 citation statements)

References 6 publications

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“… 25 , 26 However, the accuracy of FIB-4 <1.30 in patients with T2DM to rule out patients with intermediate/high risk of AF has been questioned and requires further investigation. 27 , 28 Finally, the retrospective design cannot exclude potential bias in the patient selection and medical decision for hepatology referral, furthering the need for prospective studies using a standardized protocol. 29 Such a study is currently ongoing in the two diabetology and nutrition departments from Lyon University Hospital and will help to determine the optimal pathway referral for risk stratification of patients with TD2M and/or obesity and NAFLD in diabetology and nutrition clinics (NCT04435054).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Pathway Referrals for Liver Fibrosis Risk Stratification Performed in Diabetology and Nutrition Clinics

Caussy,

Telliam,

Al-Nuaimi

et al. 2023

DMSO

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Purpose A systematic screening for the presence of nonalcoholic fatty liver disease (NAFLD)-related advanced fibrosis is currently recommended in patients with type 2 diabetes mellitus (T2DM) and obesity. However, real-world data of such liver fibrosis risk stratification pathway from diabetology and nutrition clinics towards hepatology clinics are scarce. Therefore, we compared data from two pathways with or without transient elastography (TE) performed in diabetology and nutrition clinics. Patients and Methods This is a retrospective study comparing the proportion of patients with intermediate/high risk of advanced fibrosis (AF) as defined by a liver stiffness measurement (LSM) ≥8kPa, among patients referred in hepatology from two diabetology-nutrition departments at Lyon University Hospital, France between November 1st 2018 to December 31st 2019. Results Among the two diabetology and nutrition departments using TE or not, 27.5% (62/225) versus 44.2% (126/285) were referred to hepatology, respectively. The pathway using TE in diabetology and nutrition referred to hepatology a higher proportion of patients with intermediate/high risk of AF compared to the pathway without TE: 77.4% versus 30.9%, p<0.001. In the pathway with TE, the odds of patients with intermediate/high risk of AF referred to hepatology was significantly higher: OR: 7.7, 95% CI: 3.6–16.7, p<0.001 after adjustment for age, sex and presence of obesity and T2D compared to the pathway without TE in diabetology and nutrition clinics. However, among the patients not referred, 29.4% had an intermediate/high risk of AF. Conclusion A pathway-referral using TE performed in diabetology and nutrition clinics, significantly improves the liver fibrosis risk stratification and avoids over-referral. However, collaboration between diabetologist, nutritionists and hepatologists is needed to avoid under-referral.

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Section: Discussionmentioning

confidence: 99%

Comparison of Pathway Referrals for Liver Fibrosis Risk Stratification Performed in Diabetology and Nutrition Clinics

Caussy,

Telliam,

Al-Nuaimi

et al. 2023

DMSO

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“… 53 There are several potential reasons why NITs would underperform in T2DM. 24 , 53 , 54 Indeed, patients with T2DM may only represent a relatively small part of the whole spectrum of MAFLD severity, resulting in potential spread effect. Moreover, certain glucose-lowering agents (e.g., glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, glitazones) or lipid-lowering drugs (e.g., fibrates) could be potential confounders by modulating liver fat accumulation and/or measurements used to calculate the scores (e.g., ALT, AST, triglycerides, or BMI).…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional Real-life Study of the Prevalence, Severity, and Determinants of Metabolic Dysfunction-associated Fatty Liver Disease in Type 2 Diabetes Patients

Binet¹,

Loumaye²,

Hermans³

et al. 2023

J Clin Transl Hepatol

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Background and Aims Most data on liver assessment in type 2 diabetes mellitus (T2DM) patients are from retrospective cohorts with selection bias. We aimed at appraising the feasibility, results, and benefits of an outpatient systematic noninvasive screening for metabolic dysfunction-associated fatty liver disease (MAFLD) severity and determinants in T2DM patients. Methods We conducted a 50-week cross-sectional study enrolling adult T2DM outpatients from a diabetes clinic. An algorithm based on guidelines was applied using simple bioclinical scores and, if applicable, ultrasound and/or elastometry. Results Two hundred and thirteen patients were included. Mean age and body mass index were 62 years and 31 kg/m 2 and 29% of patients had abnormal transaminase levels. The acceptance rate of additional liver examinations was 92%. The prevalence of MAFLD, advanced fibrosis and cirrhosis was 87%, 11%, and 4%, respectively. More than half of the cases of advanced fibrosis had not been suspected and were detected by this screening. MAFLD was associated with poor glycemic control, elevated transaminases, low HDL-C and the absence of peripheral arterial disease. Advanced fibrosis was linked to high waist circumference and excessive alcohol consumption, which should be interpreted with caution owing to the small number of patients reporting excessive consumption. Conclusions Simple bioclinical tools allowed routine triage of T2DM patients for MAFLD severity, with high adherence of high-risk patients to subsequent noninvasive exams.

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“…Despite a large proportion of our patients with an HSI suggestive of hepatic steatosis at enrollment, a surprisingly small number of individuals went on to be predicted to be at high risk of fibrosis according to the FIB-4 score during follow-up. The FIB-4 score has been observed to have an unexpectedly high false-negative rate in patients with type 2 diabetes, particularly at the intermediate-risk cut-off of 1.3 ( 56 , 57 ). The FIB-4 score is also reported to have a high false negative rate in individuals under the age of 35 years and an increased false positive rate in individuals over 65, partially attributed to the inclusion of age in the FIB-4 calculation ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

Associations between neck circumference and markers of dysglycemia, non-alcoholic fatty liver disease, and dysmetabolism independent of Body Mass Index in an Emirati population

2022

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AimNeck circumference (NC) is quick and easy to measure and may be a useful surrogate marker for body composition. We investigated NC as a potential marker of dysglycemia, MetS, and NAFLD.Methods674 individuals were recruited at the Imperial College London Diabetes Centre in a study of sleep apnea prevalence. Of these, 547 (Age 46 ± 11.4 years, Body Mass Index (BMI) 31 ± 6 kg/m2, 279 (51%) female, 113 normal glucose tolerance (NGT), 108 Prediabetes, 326 Type 2 diabetes (T2DM)) met all inclusion criteria for analysis. NC was measured at the thyroid cartilage, and collar size was recorded. Analysis was performed using univariate and multivariate linear regression.ResultsAdjusted for BMI, sex, and age, NC was 0.65 ± 0.3 cm greater in prediabetes (p = 0.0331), and 1.07 ± 0.28 cm greater in T2DM, compared with NGT (p = 0.0002). Adjusting for BMI, sex, and glycemic status, 1-cm increase in NC was associated with a 1.04 ± 1.01 U/L (p <0.0001) increase in ALT and, additionally, correcting for statin use, a 0.03 ± 0.01 mmol/L reduction in HDL (p <0.0001) and a 0.1 ± 0.02 increase in TC : HDL. A 1 cm increase in NC was associated with a 1.15 ± 1.02% (p <0.0001) increase in 10-year AHA cardiovascular risk in individuals over 40 years old and a 0.16 ± 0.02 (p <0.0001) increase in NAFLD fibrosis score. The neck circumference was associated with the hazard of new onset of deranged ALT adjusted for age, sex, glycemic status, and BMI (hazard ratio 1.076 (95% CI 1.015–1.14, p = 0.0131) and with the incidence of Fatty Liver Index associated with high probability of NAFLD (hazard ratio 1.153 (95% CI 1.019–1.304), p = 0.0239).ConclusionNC is associated with dysglycemia, components of the MetS, and factors predictive of NAFLD, but does not appear to independently predict subsequent progression to high risk of liver fibrosis in this predominantly diabetic population.

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Low accuracy of FIB-4 test to identify people with diabetes at low risk of advanced fibrosis

Cited by 13 publications

References 6 publications

Comparison of Pathway Referrals for Liver Fibrosis Risk Stratification Performed in Diabetology and Nutrition Clinics

Comparison of Pathway Referrals for Liver Fibrosis Risk Stratification Performed in Diabetology and Nutrition Clinics

A Cross-sectional Real-life Study of the Prevalence, Severity, and Determinants of Metabolic Dysfunction-associated Fatty Liver Disease in Type 2 Diabetes Patients

Associations between neck circumference and markers of dysglycemia, non-alcoholic fatty liver disease, and dysmetabolism independent of Body Mass Index in an Emirati population

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