Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh Type 2 Diabetes Study

Grecian, Sheila M.; McLachlan, Stela; Fallowfield, Jonathan A.; Kearns, Patrick K.A.; Hayes, Peter C.; Guha, Neil I.; Morling, Joanne R.; Glancy, Stephen; Williamson, Rachel M.; Reynolds, Rebecca M.; Frier, Brian M.; Zammitt, Nicola N.; Price, Jackie F.; Strachan, Mark W.J.

Abstract

Background
The incidence of cirrhosis and hepatocellular carcinoma (HCC) is increased in Type 2 diabetes, primarily secondary to non‐alcoholic fatty liver disease (NAFLD). European guidelines recommend screening for NAFLD in Type 2 diabetes. American guidelines, while not advocating a screening protocol, suggest using non‐invasive markers of fibrosis for risk‐stratification and guiding onward referral.

Aims
To test the ability of individual fibrosis scores and the European screening algorithm to predict 11‐year incident cirrhosis/HCC in an asymptomatic community cohort of older people with Type 2 diabetes.

Methods
The Edinburgh Type 2 Diabetes Study investigated men and women with Type 2 diabetes (n = 1066, aged 60–75 at baseline). Liver markers were measured at baseline and year 1; steatosis and fibrosis markers were calculated according to independently published calculations. During 11 years of follow‐up, cases of cirrhosis and HCC were identified.

Results
Forty‐three out of 1059 participants with no baseline cirrhosis/HCC developed incident disease. All scores were significantly associated with incident liver disease by odds ratio (P [less than] .05). The ability of the risk‐stratification tools to accurately identify those who developed incident cirrhosis/HCC was poor with low‐positive predictive values (5‐46%) and high false‐negative and ‐positive rates (up to 60% and 77%) respectively. When fibrosis risk scores were used in conjunction with the European algorithm, they performed modestly better than when applied in isolation.

Conclusions
In a cohort with a moderately low incidence of cirrhosis/HCC, existing risk scores did not reliably identify participants at high risk. Better prediction models for cirrhosis/HCC in people with Type 2 diabetes are required.

Citation

Grecian, S. M., McLachlan, S., Fallowfield, J. A., Kearns, P. K., Hayes, P. C., Guha, N. I., …Strachan, M. W. (2020). Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh Type 2 Diabetes Study. Liver International, 40(9), 2252-2262. https://doi.org/10.1111/liv.14590

• Journal Article Type: Article
• Acceptance Date: Jun 30, 2020
• Online Publication Date: Jul 7, 2020
• Publication Date: 2020-09
• Deposit Date: Aug 6, 2020
• Publicly Available Date: Aug 6, 2020
• Journal: Liver International
• Print ISSN: 1478-3223
• Electronic ISSN: 1478-3231
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 9
• Pages: 2252-2262
• DOI: https://doi.org/10.1111/liv.14590
• Public URL: https://nottingham-repository.worktribe.com/output/4752440
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/liv.14590