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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 Neil; Nee, Lisa D.; Glancy, Stephen; Williamson, Rachel M.; Robertson, Christine M.; Strachan, Mark W.J.; Price, Jackie F.

Authors

Joanne R. Morling joanne.morling@nottingham.ac.uk

Jonathan A. Fallowfield Jonathan.Fallowfield@ed.ac.uk

Indra Neil Guha neil.guha@nottingham.ac.uk

Lisa D. Nee

Stephen Glancy

Rachel M. Williamson

Christine M. Robertson

Mark W.J. Strachan

Jackie F. Price

Abstract

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.

METHODS: 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.

RESULTS: 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%).

CONCLUSIONS: 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
Publication Date Feb 28, 2014
Journal Journal of Hepatology
Print ISSN 0168-8278
Electronic ISSN 1600-0641
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 60
Issue 2
Institution Citation Morling, J. R., Fallowfield, J. A., Guha, I. N., Nee, L. D., Glancy, S., Williamson, R. M., …Price, J. F. (2014). Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: the Edinburgh type 2 diabetes study. Journal of Hepatology, 60(2), doi:10.1016/j.jhep.2013.10.017
DOI https://doi.org/10.1016/j.jhep.2013.10.017
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
Publisher URL https://www.sciencedirect.com/science/article/pii/S0168827813007423?via%3Dihub
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0




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