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.

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.

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), 384-391. https://doi.org/10.1016/j.jhep.2013.10.017

• 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
• 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
• Public URL: https://nottingham-repository.worktribe.com/output/722686
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0168827813007423?via%3Dihub
• Contract Date: May 23, 2018