Association Of Non-Invasive Liver Fibrosis Scores With Microvascular Complications In Adults With Type 2 Diabetes Mellitus

Objective: To determine the association between noninvasive liver fibrosis scores and selected microvascular complications among Ghanaian adults with type 2 diabetes mellitus (T2DM). Methodology: We conducted a retrospective secondary analysis of 242 adults with T2DM attending a tertiary diabetes centre in Ghana. Clinical and laboratory data were obtained from a parent vascular complications study. Fibrosis-4 Index (FIB-4), NAFLD Fibrosis Score (NFS), and AST-to-Platelet Ratio Index (APRI) were calculated. Selected microvascular complications comprised diabetic kidney disease (DKD) and peripheral neuropathy. Associations were assessed using logistic regression and receiver operating characteristic (ROC) curve analysis. Results: Selected microvascular complications were present in 51 participants (21.1%). Participants with complications were older and had a longer duration of diabetes. In unadjusted analyses, NFS was associated with any microvascular complication (OR 1.40, 95% CI 1.07-1.83; p=0.013) and DKD (OR 1.64, 95% CI 1.20- 2.24; p=0.002). However, these associations were not significant after adjustment for age, sex, body mass index, and hypertension. FIB-4 and APRI were not associated with any outcome. NFS demonstrated modest discrimination for the composite outcome (AUC 0.620, 95% CI 0.524-0.716) and DKD (AUC 0.689, 95% CI 0.580-0.798), whereas FIB-4 and APRI showed poor discriminatory performance. Conclusion: NFS showed an unadjusted association with selected microvascular complications, particularly DKD, but no fibrosis score remained independently associated with these outcomes after adjustment. The overall discriminatory performance of the fibrosis scores was limited, suggesting limited utility as standalone tools for microvascular risk stratification in T2DM.