FREQUENCY OF NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) RELATED CIRRHOSIS IN DIABETES MELLITUS USING ASPARTATE AMINOTRANSFERASE TO PLATELET RATIO INDEX (APRI) AND FIBROSIS-4 SCORE

Background: Diabetes mellitus is a metabolic disorder characterized by high blood sugar levels. This results from the body's inability to properly use insulin, leading to impaired carbohydrate metabolism and overproduction of glucose. Objectives: To study the frequency of NAFLD related cirrhosis in Diabetes Mellitus (DM) using APRI and fibrosis-4 (FIB-4) score. Methods: We conducted a descriptive cross-sectional study to include 180 individuals of DM with NAFLD presenting at Pakistan Railways Hospital, Rawalpindi from 21st July, 2024 till 20th January, 2025. Patients were included by non-probability consecutive sampling between 18 to 75 years of age. Venous sample was taken for fasting blood glucose, random blood glucose, ALT, AST and platelets. APRI and fibrosis-4 scores were calculated. A higher and lower cut off value of >3.25 and <1.45 for FIB-4 and APRI values of >1.5 and <0.5 were be taken as the higher and lower cut off for identifying individuals with cirrhosis. Scores that had come in between these cut off were taken as inconclusive. SPSS version 26.0 was used for data analysis. Results: Out of 180 individuals, 56 (31.1%) were male and 126 (68.9%) were female. The mean age was 59.90 ± 9.71 years. NAFLD-related cirrhosis was detected in 18 individuals (10%) using the APRI score and in 26 people (14.44%) using the FIB-4 score. Among patients with Grade 1 NAFLD, cirrhosis was present in 16 (8.88%) and 24 (13.33%) patients based on the APRI and FIB-4 scores, respectively. No cases of cirrhosis were observed in Grade 2 NAFLD. In Grade 3, cirrhosis was observed in 2 patients (1.11%) according to each scoring system. Conclusion: This study emphasizes the demand for routine screening of diabetic and NAFLD patients for advanced fibrosis to enable timely intervention or referral to hepatology specialists.