Prevalence of significant hepatic fibrosis and cirrhosis assessed by various non-invasive scores in patients attending the diabetic clinic
Jun Liong Chin, Grace Chan, Niamh Nic Cinneide, James Trayer, Abdur Aftab, Garry Courtney, Colm McGurk
St. Luke's General Hospital, Kilkenny
Non-alcohol fatty liver disease (NAFLD) is common in diabetic patients with the metabolic syndrome. Patients with NAFLD can develop steatohepatitis and progress to cirrhosis. A number of non-invasive scores have been developed to identify patients at high risk of significant hepatic fibrosis and cirrhosis.
The aim of this study is to apply a number of validated scores in patients attending the diabetic clinic to assess the prevalence of significant fibrosis and cirrhosis.
We retrospectively examined all patients attending the diabetic clinic from March to June 2014 and included patients with type 2 diabetes. Patients with type 1 diabetes and gestational diabetes were excluded. Data were obtained from laboratory database and electronic diabetic patient record (Cellma). We applied the NAFLD fibrosis score (NFS), Fib-4 score, AST to Platelet Ratio Index(APRI), AST/ALT ratio and BARD score, to assess the prevalence of significant hepatic fibrosis and cirrhosis, in patients with diabetes.
Of the 521 patients screened, only 29.4% (153) of patients with complete laboratory data were studied. In our cohort of 153 patients, the median age was 63 (IQR 56.0–71.5) years and 64.1% (98) of patients were male. More than half of our patients (56.2%; n=86) had a BMI>30kg/m2. Of these, 14.4% of patients had a BMI >40kg/m2, 14.4% had a BMI of 35-40kg/m2 and 27.5% had a BMI of 30-35kg/m2. Using the NFS, almost a quarter of our patients (24.2%, n=37) had significant fibrosis with a median score of 1.169(0.898–1.563). The majority of our diabetic patients (66.0%, n=101) had an indeterminate score of -0.224(- 0.744–0.302). Only 15 (9.8%) patients had no significant fibrosis with a score of -1.820(-2.500– -1.550). With the Fib-4 score, only one patient had significant fibrosis. 62.1% of patients had no significant hepatic fibrosis [Fib-4 score of 1.08(0.86-1.29)] while 37.3% had an indeterminate score [1.78(1.59-2.41)]. Using the APRI, only 1.3% of patients were found to have cirrhosis [median APRI 1.18(1.10-1.25)] while 4.6% of patients had significant hepatic fibrosis [0.78(0.72-0.83)]. Conversely, using the AST/ALT ratio and BARD score, the prevalence of significant hepatic fibrosis was 60.1% and 90.2% respectively, for diabetic patients.
Identifying diabetic patients with significant hepatic fibrosis and cirrhosis remains challenging in clinical practice despite the description of various non-invasive scores. The prevalence of significant hepatic fibrosis and cirrhosis differ considerably depending on the score applied.