Clinical utility of non-invasive markers in the assessment of liver fibrosis among type 2 diabetes mellitus patients

Abstract Objectives To explore the utility of several readily available, cost-effective, non-invasive tests in assessing liver fibrosis, as measured by fibro scan, in patients with type 2 diabetes mellitus (DM). Methods A total of 120 type 2 DM patients were enrolled in the present cross-sectional study. Liver fibrosis was assessed using FibroScan via liver stiffness measure (LSM). Serum-based non-invasive measures and ultrasound scan results were collected. Results Moderate or advanced fibrosis (LSM≥7 kPa) was detected in 24.2 % of patients. These patients had significantly higher triglyceride (p=0.020) and glycated hemoglobin (HbA 1C ) (p=0.020) than those without fibrosis. Factors associated with LSM were total cholesterol (95 % CI 0.001–0.056, p=0.042) and HbA 1C (95 % CI 0.143–1.810, p=0.022). Fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and non-alcoholic fatty liver disease (NAFLD) fibrosis score were significantly and positively correlated with LSM. A new index; FibroMet, showed a positive and significant correlation with FIB-4, NAFLD fibrosis score, and APRI. Ultrasonically diagnosed grade of liver fibrosis didn’t show any correlations with LSM. When LSM is served as the reference, the area under the ROC curve of FIB-4 was 0.630 (95 % CI 0.521–0.740, p=0.035), NAFLD fibrosis score was 0.647 (95 % CI 0.540–0.754, p=0.018), APRI was 0.629 (95 % CI 0.504–0.754, p=0.036), and FibroMet was 0.686 (95 % CI 0.574–0.798, p=0.003) to identify moderate and advanced fibrosis. Long-term glucose and lipid control are associated with reduced LSM in type 2 DM patients. Conclusions Serum-based non-invasive scores and FibroMet index have better clinical sensitivity and validity over ultrasound scan in terms of assessing liver fibrosis in type 2 DM patients.