S2804 Evaluating APRI as a Fibrosis Marker in Diabetic MASH: A Cross-Sectional Analysis

Introduction: Non-invasive biomarkers are commonly used to evaluate liver fibrosis and steatosis in patients with metabolic dysfunction-associated steatotic liver disease (MASH), especially in those with type 2 diabetes. The aspartate aminotransferase-to-Platelet Ratio Index (APRI) is a simple and accessible marker, but its concordance with imaging-based parameters such as liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and ultrasound-based fatty liver grading remains uncertain. This study assessed the relationship between APRI and both imaging-based and biochemical fibrosis measures, particularly the FIB-4 score, in diabetic individuals. Methods: This cross-sectional study included 400 patients with type 2 diabetes mellitus who underwent liver fibrosis assessment. APRI and FIB-4 scores were calculated using routine laboratory parameters. FibroScan was used to obtain LSM and CAP values, while fatty liver was graded by ultrasound. Associations between APRI and categorical fibrosis or steatosis grades were analyzed using Kruskal-Wallis and Wilcoxon-Mann-Whitney U tests, and statistical significance was tested with the Chi-square test (χ²). Correlations between APRI and continuous variables (LSM, CAP, and FIB-4) were evaluated using Spearman’s rank correlation coefficient (ρ), with thresholds defined as strong (ρ ≥ 0.70), moderate (ρ = 0.40–0.69), weak (ρ = 0.10–0.39), or none (ρ < 0.10). A P-value < 0.05 was considered statistically significant. Results: No significant association was found between APRI and imaging-based fibrosis (χ² = 0.764, P = 0.858) or ultrasound-based steatosis grades (χ² = 1.351, P = 0.717). APRI showed weak, non-significant correlations with both LSM (ρ = 0.02, P = 0.629) and CAP (ρ = 0.03, P = 0.525). In contrast, APRI demonstrated a strong and statistically significant correlation with the FIB-4 score (ρ = 0.88, P < 0.001). Patients with FIB-4 >2.67 had significantly higher APRI values compared to those with intermediate FIB-4 scores (1.07 vs 0.52, P < 0.001). Conclusion: APRI strongly correlates with the FIB-4 score, however it shows no meaningful association with elastographic or sonographic indicators of liver fibrosis or steatosis in diabetic patients. These findings suggest that APRI may be reliable as a biochemical marker but has limited utility in reflecting imaging-based liver pathology.