Screening for cirrhosis secondary to Non-alcoholic fatty liver disease (NAFLD) in a diabetes centre population using NAFLD Fibrosis Score (NFS): an externally-validated, simple, biomarker panel — ASN Events
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  3. Screening for cirrhosis secondary to Non-alcoholic fatty liver disease (NAFLD) in a diabetes centre population using NAFLD Fibrosis Score (NFS): an externally-validated, simple, biomarker panel

Screening for cirrhosis secondary to Non-alcoholic fatty liver disease (NAFLD) in a diabetes centre population using NAFLD Fibrosis Score (NFS): an externally-validated, simple, biomarker panel (#342)

Kathryn H Williams 1 2 3 , Emilia Prakoso 4 5 , Erika Cavanagh 6 , Jim Raleigh 6 , Belinda Brooks 3 7 , Nick Shackel 4 5 , Stephen M Twigg 2 3
  1. The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, NSW, Australia
  2. Central Clinical School, The University of Sydney, NSW, Australia
  3. The Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  4. The AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  5. Liver Injury and Cancer Group, Centenary Institute, Camperdown, NSW, Australia
  6. The Radiology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  7. Sydney Nursing School, The University of Sydney, NSW, Australia

Readily available tools that identify diabetic patients with clinically significant liver fibrosis secondary to NAFLD are needed. The NFS is designed to categorise NAFLD fibrosis risk and it uses the following variables: age, BMI, presence of diabetes, AST, ALT, platelets and serum albumin. A high NFS is a predictor of advanced NAFLD and also mortality.

Method: Patients were randomly recruited from a tertiary diabetes centre and excluded if they reported significant current alcohol intake or liver disease other than NAFLD. Each patient underwent a clinical assessment, fasting blood tests, liver ultrasound and assessment of liver fibrosis by transient elastography (FibroScan®). XL probe readings were used unless unavailable. A FibroScan® measure of ≥10.3kPa was considered consistent with cirrhosis.

Results: A total of 102 serial patients completed all assessments (61% male and 97% type 2 diabetes). Results are presented as either mean ± SD or median and IQR: age 62 ± 10 years, duration of diabetes 11 (IQR: 5 - 15 years), BMI 30.9 ± 5.8 kg/m2 and HbA1c 7.6 ± 1.2 %. Steatosis was present on ultrasound in 88% of patients and FibroScan® ≥10.3kPa in 19%. NFS classified 28 patients ‘low risk’, of whom one had a FibroScan® ≥10.3kPa (history of heavy alcohol consumption >10 years previously). Of the 65 patients classified as ‘intermediate risk’, 13 had a FibroScan® ≥10.3kPa. Of the 9 patients classified ‘high risk’, 6 had a FibroScan® ≥10.3kPa; one patient had a FibroScan® of 9.2kPa and cirrhosis could not be excluded. The other 2 of 9 patients were either morbidly obese or elderly.

Conclusions: Severe liver fibrosis secondary to NAFLD is prevalent in patients with type 2 diabetes. When applied in a correct clinical setting, a ‘low risk’ NFS adds value as it helps to exclude cirrhosis. NFS accuracy in ‘intermediate risk’ would likely be improved in combination with other biomarkers or FibroScan®.

  1. Angulo P, Hui JM, Marchesini G et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007; 45:846-854
  2. Therneau TM, Kim D, Kim WR, Kim HJ. Association between Non-invasive Fibrosis Markers and Mortality Among Adults With Nonalcoholic Fatty Liver Disease in the United States. Hepatology 2013; 57:1357-1365
  3. Treeprasertsuk S, Bjönsson E, Enders F et al. NAFLD fibrosis score: A prognostic predictor for mortality and liver complications among NAFLD patients. World J of Gastoenterol 2013; 19(8):1219-1229
  4. Williams KH, Shackel NA, Gorrell MD et al. Diabetes and Nonalcoholic Fatty Liver Disease: a pathogenic duo. Endocr Rev 2013; 34(1): 84-129
  5. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Annals of Medicine 2011; 43(8): 617-649
  6. Simo KA, McMillan MT, Ahrens WA et al. Calculated “NAFLD Fibrosis Scores” do not accurately predict degree of hepatic fibrosis in a bariatric patient population. Hepatology 2012; 56(1) 812A
  7. Simo KA, McMillan MT, Ahrens WA et al. Calculated “NAFLD Fibrosis Scores” do not accurately predict degree of hepatic fibrosis in a bariatric patient population. Hepatology 2012; 56(1) 812A
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