Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
Diabetes Care. 2022 Oct 1;45(10):2449-2451. doi: 10.2337/dc22-0556.
Fatty liver disease (FLD) is prevalent in diabetes, and both disproportionately affect vulnerable populations. The FIB-4 index is recommended to screen for advanced liver fibrosis. Limited data have suggested that diabetes may impact FIB-4.
We evaluated FIB-4 accuracy for advanced fibrosis compared with liver biopsy in the presence of diabetes and obesity.
Among 363 FLD patients receiving care in San Francisco's safety net health care system from August 2009 to February 2020, characteristics were as follows: median age 51 years, 46% male, 59% Hispanic, 68% obese, 33% with diabetes, and 31% with advanced fibrosis on histology. Overall, the c-statistic for FIB-4 was 0.79, but was worse in patients with diabetes, 0.68, than without, 0.85 (P = 0.003). Accuracy also varied by weight, at 0.65, 0.85, and 0.75 for normal weight, overweight, and obese, respectively, although not significantly (P = 0.24).
The findings highlight limitations of FIB-4 in screening for advanced liver fibrosis, particularly in individuals with diabetes.
脂肪肝疾病（FLD）在糖尿病中较为普遍，且两者都不成比例地影响弱势人群。FIB-4 指数被推荐用于筛查晚期肝纤维化。有限的数据表明，糖尿病可能会影响 FIB-4。
我们评估了 FIB-4 在存在糖尿病和肥胖症的情况下，对晚期纤维化的准确性与肝活检进行比较。
在 2009 年 8 月至 2020 年 2 月期间，旧金山安全网医疗保健系统中接受治疗的 363 名 FLD 患者中，其特征如下：中位年龄为 51 岁，46%为男性，59%为西班牙裔，68%为肥胖，33%患有糖尿病，31%的患者在组织学上存在晚期纤维化。总体而言，FIB-4 的 C 统计量为 0.79，但在患有糖尿病的患者中为 0.68，而在没有糖尿病的患者中为 0.85（P=0.003）。准确性也因体重而异，分别为 0.65、0.85 和 0.75，适用于正常体重、超重和肥胖患者，尽管差异不显著（P=0.24）。
这些发现强调了 FIB-4 在筛查晚期肝纤维化方面的局限性，尤其是在患有糖尿病的个体中。
