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Noninvasive biomarkers failed to accurately identify hepatic fibrosis in type 2 diabetes patients

Five noninvasive biomarkers, examined as an alternative to liver biopsy in patients with nonalcoholic fatty liver disease, correlated poorly in determining hepatic fibrosis among patients with type 2 diabetes in a recent study.

As part of the Edinburgh Type 2 Diabetes Study, researchers conducted a population-based cohort study of 831 patients with diabetes, aged 60 to 74 years, to determine correlations between five biomarkers previously used to detect liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Researchers used ultrasound to assess fatty liver, and they measured patients’ aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), Fibrosis-4 Score (FIB4), European Liver Fibrosis panel (ELF) and liver stiffness measurement (LSM).

Of 767 patients with complete biomarker data available, 282 met criteria for NAFLD — defined as hepatic steatosis on ultrasound without alcohol excess or treatment with hepatoxic medication and a negative liver screen — including 248 with LSM. Using literature-based validation cut-offs, researched determined broad differences in the proportions of participants with probable liver fibrosis for each biomarker within the full cohort.

Positive agreement between biomarkers in the top 5% of the cohort and for LSM agreement (9.5%-15.9%) was poor, researchers wrote. The best correlation occurred between APRI and FIB4 (76.4%), while agreement between the others ranged from 18.4% to 34.2%.

“We found poor correlation between the five biomarkers of liver fibrosis studied,” the researchers wrote. “Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease, but poor agreement on the presence of advanced disease.

“Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints.”

Disclosure: The researchers report no relevant financial disclosures.