Use of liver steatosis and fibrosis indices in overweight and obese patients with or without carbohydrate metabolism disorders

BACKGROUND: Currently, much attention is paid to the search for highly informative and non-invasive methods for screening the progression of non-alcoholic fatty liver disease (NAFLD) through the stages of «steatohepatosis-steatohepatitis-fibrosis». Such non-invasive methods include tests based on serum markers and/or biometric indicators. The differences in cut-off diagnostic thresholds for some fibrosis indices and the use of a point scale, which includes the presence/absence of diabetes or other carbohydrate metabolism disorders (CMDs) in calculating other indices (NAFLD-LFS, BARD, NFS) make the issue of the applicability of these indices in a cohort of patients with prediabetes and T2DM relevant. AIM: To study clinical and laboratory associations of liver steatosis and fibrosis indices in overweight and obese patients depending on CMD, and to evaluate the diagnostic significance of individual steatosis and fibrosis indices in this cohort of patients. MATERIALS AND METHODS: All patients underwent a comprehensive clinical and laboratory examination, liver fibrosis screening by ultrasound liver fibroelastometry, and liver MRI in IDEAL-IQ mode. The steatosis index FLI and fibrosis indices FIB-4, APRI, BARD, and NFS were calculated. Statistical processing of the results included comparative analysis, frequency analysis, correlation — and ROC analysis. RESULTS: The study included 114 patients with overweight or obesity divided into groups depending on the CMD: group 1 — without CMD (n=52), group 2 — prediabetes (n=34), group 3 — newly diagnosed T2DM (n=28). We verified significant differences depending on CMD only for the NFS index: in individuals with T2DM, the NFS index was significantly higher than in individuals with impaired glucose tolerance (IGT) and significantly higher than in the group without CMD. In IGT patients, the NFS values significantly exceeded those in the group without CMD. According to the APRI and FIB4 assessment, no cases of advanced (≥F2) fibrosis were found in the obtained sample. The APRI index demonstrated sufficient informative value regarding F2 fibrosis (area under the curve=0.687; p=0.008) in the cohort of obese and overweight patients without taking into account the CMD. CONCLUSION: Non-invasive tests have potential for detecting liver fibrosis, but require further study regarding applicability to a cohort of patients with CMD.