Deb Rajat, Goswami Soumik, Sengupta Nilanjan, Baidya Arjun, Khare Vibhu R, Datta Joydip, Das Mousumi, Ray Debes
Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Biochemistry, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
Indian J Endocrinol Metab. 2025 Mar-Apr;29(2):237-241. doi: 10.4103/ijem.ijem_457_24. Epub 2025 Apr 29.
Liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly related to hepatic and extrahepatic outcomes. Clinically Significant Liver Fibrosis (CSLF) screening using FIB-4 score is mandated in all T2D patients. The existing FIB-4 cutoff of 1.3 is derived from Western studies and could differ for Indians. Hence, we aimed to determine the FIB-4 cutoff to rule out Transient Elastography (TE) proven CSLF among Indians with T2D.
551 individuals with T2D underwent laboratory tests for FIB-4 calculation and transient elastography (TE) to detect CSLF defined as Liver Stiffness Measurement (LSM) ≥ 8kPa. The Receiver Operative Characteristic (ROC) curve was used to determine the optimum cutoff value of FIB4 to rule out CSLF.
129 (23.4%) of 551 T2D patients in our cohort had CSLF. We found that a FIB-4 of 1.5 rules out CSLF with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Diagnostic Accuracy (DA) of 82.9%, 79.9%, 55.7%, 93.8%, and 80.6%, respectively, compared with a FIB4 of 1.3 which has values of 91.5%, 67.3%, 46.1%, 96.2%, and 72.9%, respectively.
A FIB-4 cutoff of 1.5 rather than 1.3 is suggested for Indian subjects with T2DM and needs to be validated in further large multicenter prospective studies, preferably with histopathology as the gold standard.
代谢功能障碍相关脂肪性肝病（MASLD）中的肝纤维化与肝脏及肝外结局密切相关。所有2型糖尿病患者均需使用FIB-4评分进行临床显著肝纤维化（CSLF）筛查。现有的FIB-4临界值1.3源自西方研究，可能不适用于印度人。因此，我们旨在确定FIB-4临界值，以排除2型糖尿病印度患者中经瞬时弹性成像（TE）证实的CSLF。
551例2型糖尿病患者接受了实验室检查以计算FIB-4，并进行瞬时弹性成像（TE）以检测定义为肝脏硬度测量（LSM）≥8kPa的CSLF。采用受试者操作特征（ROC）曲线确定排除CSLF的FIB4最佳临界值。
我们队列中的551例2型糖尿病患者中有129例（23.4%）患有CSLF。我们发现，FIB-4值为1.5时排除CSLF的灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性（DA）分别为82.9%、79.9%、55.7%、93.8%和80.6%，而FIB4值为1.3时的相应值分别为91.5%、67.3%、46.1%、96.2%和72.9%。
建议2型糖尿病印度受试者的FIB-4临界值为1.5而非1.3，且需要在进一步的大型多中心前瞻性研究中进行验证，最好以组织病理学作为金标准。
