Calapod Ovidiu Paul, Marin Andreea Maria, Pantea Stoian Anca, Fierbinteanu-Braticevici Carmen
Department of Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Diagnostics (Basel). 2022 Jul 29;12(8):1829. doi: 10.3390/diagnostics12081829.
Background and Objectives: Non-alcoholic fatty liver disease (NAFLD)-related severe liver fibrosis is associated with a higher risk of progressing to decompensated cirrhosis and hepatic failure and developing NAFLD-related hepatocellular carcinoma (HCC), particularly in populations with diabetes. Our pilot study aims to evaluate the performances of various noninvasive methods in predicting liver fibrosis in a population of patients with diabetes and to establish a new scoring system for the prediction of severe fibrosis (>F3). Materials and Methods: A total of 175 patients with diabetes were enrolled for liver fibrosis evaluation. Using the degree of agreement (concordance) between a noninvasive score based on serum biomarkers (NAFLD fibrosis score) and point shear-wave elastography (pSWE) as the reference method, we generated receiver operating characteristic (ROC) curves and performed a multivariate analysis to predict severe liver fibrosis. Results: In our population of patients with diabetes, gamma-glutamyltransferase (GGT), age, body mass index (BMI), the homeostatic model assessment of insulin resistance (HOMA-IR), and glycosylated hemoglobin (HbA1C) were significant predictors for the diagnosis of the F3/F4 group (area under the ROC: 0.767, 0.743, 0.757, 0.772, and 0.7, respectively; p < 0.005 for all). Moreover, the combined composite score (the sum of GGT, age, BMI, HOMA index, and HbA1C) had the highest diagnostic performance at a cut-off value of 3 (AUROC—0.899; p < 0001). The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 91.20%, 79%, 79%, and 89%, respectively, and 89% of patients were correctly classified as having severe liver fibrosis. In contrast with the Fibrosis 4 (FIB-4) score and the AST-to-platelet ratio index (APRI), the composite score had the best accuracy in discriminating advanced fibrosis. Conclusions: The proposed composite score had a reliable and acceptable diagnostic accuracy in identifying patients with diabetes at risk of having severe fibrosis using readily available laboratory and clinical data.
非酒精性脂肪性肝病（NAFLD）相关的严重肝纤维化与进展为失代偿期肝硬化和肝衰竭以及发生NAFLD相关肝细胞癌（HCC）的风险较高有关，尤其是在糖尿病患者群体中。我们的初步研究旨在评估各种非侵入性方法在预测糖尿病患者群体肝纤维化方面的性能，并建立一种用于预测严重纤维化（>F3）的新评分系统。材料与方法：共纳入175例糖尿病患者进行肝纤维化评估。以基于血清生物标志物的非侵入性评分（NAFLD纤维化评分）与点剪切波弹性成像（pSWE）之间的一致性程度作为参考方法，我们生成了受试者操作特征（ROC）曲线，并进行多变量分析以预测严重肝纤维化。结果：在我们的糖尿病患者群体中，γ-谷氨酰转移酶（GGT）、年龄、体重指数（BMI）、胰岛素抵抗稳态模型评估（HOMA-IR）和糖化血红蛋白（HbA1C）是F3/F4组诊断的显著预测指标（ROC曲线下面积分别为：0.767、0.743、0.757、0.772和0.7；所有p<0.005）。此外，联合综合评分（GGT、年龄、BMI、HOMA指数和HbA1C之和）在截断值为3时具有最高的诊断性能（AUROC—0.899；p<0.001）。敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）分别为91.20%、79%、79%和89%，89%的患者被正确分类为患有严重肝纤维化。与纤维化4（FIB-4）评分和AST与血小板比值指数（APRI）相比，综合评分在区分晚期纤维化方面具有最佳准确性。结论：所提出的综合评分在使用现成的实验室和临床数据识别有严重纤维化风险的糖尿病患者方面具有可靠且可接受的诊断准确性。
