Clinical care and other categories posters: Lipids and fatty liver

Serum hyaluronic acid improves the performance of the fibrosis-4 index in the identification of advanced liver disease in type 2 diabetes: The Edinburgh Type 2 Diabetes Study

SM Grecian¹, S McLachlan¹, JA Fallowfield², IN Guha³, JR Morling³, RM Williamson⁴, RM Reynolds⁵, NN Zammitt⁶, JF Price¹, MWJ Strachan⁴, PC Hayes², S Glancy⁷, BM Frier⁵

¹Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK, ²Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK, ³NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK, ⁴Metabolic Unit, Western General Hospital, Edinburgh, UK, ⁵Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK, ⁶Department of Diabetes and Endocrinology, Royal Infirmary of Edinburgh, Edinburgh, UK, ⁷Department of Radiology, Western General Hospital, Edinburgh, UK

Refer to Oral number A49.

SUPPORTING INFORMATION The conference poster for this abstract is available online in the Supporting Information section at the end of this page.

Which scoring system performs best in assessing fatty liver related fibrosis in diabetes?

CL Morrison¹, TS Purewal², PJ Weston²

¹Panton Surgery, Betsi Cadwaladr University Health Board, Holywell, UK, ²Diabetes Centre, Royal Liverpool University Hospital, Liverpool, UK

Aims There is a high prevalence of fatty liver disease (FLD) in the diabetes population but its presence is often overlooked. FLD is associated liver cirrhosis, hepatocellular carcinoma and cardiovascular mortality with outcomes being worse in diabetes. A number of noninvasive assessment scores using routinely collected data have been developed to help identify those at most risk.

Methods This study compared the outcomes of four tools used for scoring and risk categorising liver fibrosis in fatty liver, Fibrosis-4 index (FIB-4), NAFLD Fibrosis score (NFS), AST to Platelet Ratio Index (APRI), AST/ALT ratio. They were applied to a group subjects with diabetes and mildly elevated alanine aminotransferase (ALT) (>40 <100 IU/l), with threshold values of >1.3, >−1.455, >0.7, >1.0 of respectively.

Results In a primary care population of 44 males with diabetes (age 63.8 years (±11.8, 33–81) (mean,SD,range), HbA1c 59.6mmol/mol (±19.4, 29–131), BMI 32.8kg/m² (±5.5, 21.1–46.1), ALT 45.5 IU/l (±64,24.9, 41–99), AST 33.3 IU/l (±17.4, 8–86), platelets 228.6 10⁹/l (±67.2, 107–441), the proportion with a higher risk of fibrosis with each tool were FIB-4 47.7%(score) (1.6, ±1.2, 0.38–6.3), NFS 88.6%(0.3, ±1.1, −2.59–2.14), APRI 13.6%(0.42, ±0.32,0.08–1.92), AST/ALTratio 31.8%(0.8, ±0.32, 0.16–1.5).

Conclusion Although these scoring tools are easy and inexpensive to use in screening for fibrosis in subjects with abnormal liver blood tests, the considerable variation in proportion of subjects with high risk of fibrosis indicates the need for further evaluation of their utility in a primary care population with diabetes. A more effective approach may be to use a biomarker blood test such as enhanced liver fibrosis (ELF) or imaging with fibroscan which commissioners would need to consider funding.