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Noninvasive Fibrosis Screening in Fatty Liver Disease Among Vulnerable Populations: Impact of Diabetes and Obesity on Fibrosis-4 Score Accuracy

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posted on 2022-08-10, 17:58 authored by Rebecca G. Kim, Jasmine Deng, Jewel N. Reaso, James P. Grenert, Mandana Khalili

  

Objective: Fatty liver disease (FLD) is prevalent in diabetes, and both disproportionately affect vulnerable populations. The fibrosis-4 score (FIB-4) is recommended to screen for advanced liver fibrosis. Limited data have suggested that diabetes may impact FIB-4. Research Design and Methods: We evaluated FIB-4 accuracy for advanced fibrosis compared to liver biopsy in presence of diabetes and obesity. 

Results: Among 363 FLD patients receiving care in San Francisco’s safety-net from 8/2009-2/2020, characteristics were: median age 51yrs, 46% male, 59% Hispanic, 68% obese, 33% with diabetes and 31% had advanced fibrosis on histology. Overall, the c-statistic for FIB-4 was 0.79, but was worse in patients with diabetes, 0.68, than without, 0.85 (p=0.003). Accuracy also varied by weight, at 0.65, 0.85, 0.75, for normal-weight, overweight and obese, respectively, although not significantly (p=0.24). 

Conclusions: The findings highlight limitations of FIB-4 in screening for advanced liver fibrosis, particularly in individuals with diabetes.

Funding

This work was in part supported by NIH, K24AA022523 (M.K.) and T32DK060414 (R.G.K.), and the UCSF Liver Center (P30 DK026743).

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