Authors (including presenting author) :
Lai WC(1),Tsang WCS(1),Wong CK(1),Lock KY(1),Yeung CK(1),Chan KY(1),Chui WY(1),Chuang K(1),Lee YP(1),Law CS(1),Lam YC(1)
Affiliation :
(1)Department of Medicine, Tseung Kwan O Hospital
Introduction :
Metabolic Associated Fatty Liver Disease (MAFLD) is common among type II diabetes mellitus (DM) patients. A hospital study in 2019 using transient elastography (Fibroscan) showed significant disease burden with 77.4% of DM patients had MAFLD and 14.8% had severe fibrosis or early cirrhosis (advanced fibrosis). Fibrosis is the most important prognostic factor and correlates with liver-related mortality and hepatocellular carcinoma. Ideally, liver fibrosis assessment is performed by invasive liver biopsy which is associated with small rate of serious complications, and is unsuited for screening purposes. Current guideline recommends screening for advanced fibrosis in DM patients. Recently, sequential use of non-invasive tests (FIB-4 score, NAFLD fibrosis score, fibroscan) have been shown to improve accuracy for the diagnosis of advanced fibrosis compared with individual tests alone. Patients with advanced fibrosis should be referred to hepatologist for further assessment and those without should be managed in primary care.
Objectives :
To screen for MAFLD with advanced fibrosis in DM patients using FIB-4 score followed by Fibroscan
Methodology :
Consecutive DM patients who attended complication screening were recruited. FIB-4 score was calculated from 4 parameters including age, ALT, AST and platelet count. Fibroscan was performed to measure liver stiffness and steatosis (Controlled Attenuated Parameter (CAP)) for patients with FIB-4 ≥1.3. Patients with liver stiffness >8 kPa were suspected to have advanced fibrosis.
Result & Outcome :
Three hundred and seventy-four patients were invited and 193 (51.6%) were successfully enrolled. The mean±SD age was 60.7±9.6 years, and 122 (63%) patients were male. The mean±SD BMI was 26±5 kg/m2. Coexisting obesity, hypertension and hyperlipidaemia was 53%, 76% and 93% respectively. Eighty-four (43.5%) patients had FIB-4 score ≥1.3. Twenty-one (25%) patients defaulted Fibroscan. Sixty-three (75%) of positive screened patients attended for Fibroscan. Of those 11/63 (17.5%) patients had liver stiffness>8 kPa, indicating probable advanced fibrosis. Five patients (7.9%) had liver stiffness >12kPa suggestive of probable cirrhosis.
The prevalence of steatosis as defined by CAP ≥248 dB/m was 64%. The proportion of mild, moderate and severe steatosis was 16%, 8% and 40% respectively.
Conclusion:
Sequential use of non-invasive tests for fibrosis can significantly reduce the number of specialist referrals from 14.8% to 5.7%, decrease fibroscan waiting time and is potentially cost-effective.
