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Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: The Edinburgh type 2 diabetes study

Morling, Joanne R.; Fallowfield, Jonathan A.; Guha, Indra N.; Nee, Lisa D.; Glancy, Stephen; Williamson, Rachel M.; Robertson, Christine M.; Strachan, Mark W.J.; Price, Jackie F.

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Clinical Associate Professor

Jonathan A. Fallowfield

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Professor of Hepatology

Lisa D. Nee

Stephen Glancy

Rachel M. Williamson

Christine M. Robertson

Mark W.J. Strachan

Jackie F. Price


Background & Aims
It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research.

In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured.

Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%).

We found poor correlation between the five biomarkers of liver fibrosis studied. 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, in a range of different low and high risk population groups.

Journal Article Type Article
Acceptance Date Oct 9, 2013
Online Publication Date Oct 26, 2013
Publication Date Feb 1, 2014
Deposit Date May 23, 2018
Publicly Available Date May 23, 2018
Journal Journal of Hepatology
Print ISSN 0168-8278
Electronic ISSN 1600-0641
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 60
Issue 2
Pages 384-391
Keywords Aged; Alanine Transaminase; Aspartate Aminotransferases; Biomarkers; Cohort studies; Diabetes Mellitus, Type 2; Elasticity imaging techniques; Fatty Liver; Liver Cirrhosis; Non-alcoholic fatty liver disease; Platelet count; Predictive value of tests
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