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

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.