Li Mingkai, Yu Hongsheng, Wan Sizhe, Hu Fulan, Luo Qingtian, Gong Wei
Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, People's Republic of China.
Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Diabetes Obes Metab. 2025 Mar;27(3):1184-1197. doi: 10.1111/dom.16109. Epub 2024 Dec 5.
Type 2 diabetes increases the risk of cirrhosis and liver cancer. Noninvasive and early assessment of liver fibrosis is essential. We aimed to develop a score to aid in the initial assessment of liver fibrosis in the diabetic population.
A fibrosis investigating navigator in diabetes (FIND) score was developed and validated in the NHANES dataset (2017-2020). Fibrosis was defined as a liver stiffness measurement (LSM) ≥8.0 kPa. The diagnostic accuracies of FIB-4, NFS, LiverRisk, steatosis-associated fibrosis estimator (SAFE) and metabolic dysfunction-associated fibrosis (MAF-5) were compared. FIND was also externally validated in various liver diseases via biopsy as a reference in an Asian centre between 2016 and 2020. Finally, we examined the prognostic implications of the FIND index utilizing data from the UK Biobank cohort (2006-2010).
The FIND score model yielded an AUROC of 0.781 for the prediction of an LSM ≥8 kPa in the validation set, which was consistently greater than that of other available models (all p < 0.05). In the whole NHANES dataset, the 85% sensitivity cut-off of 0.16 corresponded to a NPV of 91.9%, whereas the 85% specificity cut-off of 0.31 corresponded to a PPV of 50.6%. FIND displayed overall accuracies similar to those of the other models in staging fibrosis stages, with biopsy used as a reference. In the UK Biobank cohort, FIND >0.31 was associated with an increased risk of all-cause and liver-related mortality in the diabetic population in adjusted models (HR, 1.75; 95% CI, 1.62-1.89; HR, 23.59; 95% CI, 13.67-40.69).
In diabetes patients, the novel FIND score performs well in identifying subjects at risk of liver fibrosis and predicting all-cause and liver-related mortality.
2型糖尿病会增加肝硬化和肝癌的风险。对肝纤维化进行无创和早期评估至关重要。我们旨在开发一种评分系统，以辅助对糖尿病患者的肝纤维化进行初步评估。
在国家健康与营养检查调查（NHANES）数据集（2017 - 2020年）中开发并验证了糖尿病纤维化调查导航器（FIND）评分。肝纤维化定义为肝脏硬度测量值（LSM）≥8.0 kPa。比较了FIB - 4、NFS、LiverRisk、脂肪变性相关纤维化评估器（SAFE）和代谢功能障碍相关纤维化（MAF - 5）的诊断准确性。2016年至2020年间，在一个亚洲中心，通过活检作为参考，对FIND在各种肝脏疾病中进行了外部验证。最后，我们利用英国生物银行队列（2006 - 2010年）的数据研究了FIND指数的预后意义。
在验证集中，FIND评分模型预测LSM≥8 kPa的曲线下面积（AUROC）为0.781，始终高于其他现有模型（所有p < 0.05）。在整个NHANES数据集中，敏感性为85%时的截断值0.16对应的阴性预测值为91.9%，而特异性为85%时的截断值0.31对应的阳性预测值为50.6%。以活检为参考，FIND在肝纤维化分期中的总体准确性与其他模型相似。在英国生物银行队列中，在调整模型中，糖尿病患者FIND > 0.31与全因死亡率和肝脏相关死亡率增加相关（风险比[HR]，1.75；95%置信区间[CI]，1.62 - 1.89；HR，23.59；95% CI，13.67 - 40.69）。
对于糖尿病患者，新型FIND评分在识别有肝纤维化风险的受试者以及预测全因死亡率和肝脏相关死亡率方面表现良好。
