Identification of patients with type 2 diabetes with non-alcoholic fatty liver disease who are at increased risk of progressing to advanced fibrosis: a cross-sectional study

• Published in: BMJ open 2023-01, Vol.13 (1), p.e063959-e063959
• Main Authors: Mettananda, Chamila, Egodage, Thimira, Dantanarayana, Channaka, Fernando, Rumal, Ranaweera, Lakmali, Luke, Nathasha, Ranawaka, Chamila, Kottahachchi, Dulani, Pathmeswaran, Arunasalam, de Silva, Hithanadura Janaka, Dassanayake, Anuradha Supun
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - pathology; Elasticity Imaging Techniques - methods; Fibrosis; Gastroenterology and Hepatology; Humans; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnostic imaging; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Predictive Value of Tests; Prospective Studies
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-063959

Identification of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) is important as this may progress to cirrhosis and hepatocellular carcinoma. The risk of hepatic fibrosis is especially high among patients with diabetes with NAFLD. Annual screening of patients with diabetes for fatty liver and calculation of Fibrosis-4 (FIB-4) score and exclusion of significant fibrosis with vibration-controlled transient elastography (VCTE) have been recommended. However, VCTE is expensive and may not be freely available in resource-limited settings. We aim to identify predictors of significant liver fibrosis who are at increased risk of progression to advanced liver fibrosis and to develop a prediction model to prioritise referral of patients with diabetes and NAFLD for VCTE. This cross-sectional study is conducted among all consenting adults with type 2 diabetes mellitus with NAFLD at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All patients get the FIB-4 score calculated. Those with FIB-4 ≥1.3 undergo VCTE (with FibroScan by Echosens). Risk associations for progression to advanced liver fibrosis/cirrhosis will be identified by comparing patients with significant fibrosis (liver stiffness measure (LSM) ≥8 kPa) and without significant fibrosis (LSM