Fibrosis-4 index utility for screening liver fibrosis and its association with degenerative complications in patients with type 2 diabetes mellitus: a monocentric study

Abstract

Backgrounds. The fibrosis-4 index is a simple biomarker tool widely recommended to diagnose advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM). The primary aim of this study was to assess liver fibrosis risk among type 2 diabetes mellitus patients using the Fib-4 score, secondary to compare the prevalence of degenerative complications between patients according to Fib-4 index risk, and to evaluate the prevalence of metabolic dysfunction-associated-steatotic liver disease in our population.

Methods. This is a descriptive-analytical cross-sectional study including 600 patients with type 2 diabetes mellitus who were followed at the Endocrinology- Diabetology and Nutrition Department of a university hospital center, for a period of 8 years and 10 months from January 2016 to October 2024.

Results. The mean age in our population was 59±12.8 years. The median duration of diabetes was 6.4 years (1–15 years) with a median HbA1c value of 10.2±2.7%. Overweight and obesity were found in 39.2% and 34.5% of patients respectively, with a mean BMI of 28.2±5.9 kg/m². The median of fibrosis-4 index was 1.09. Sixty-one percent of patients had a low risk of advanced liver fibrosis, 31% had an intermediate risk, and 8% had a high risk to develop an advanced liver fibrosis. Patients with a Fib-4 score ≥1.3 (indicating intermediate to high risk of liver fibrosis) had a statistically significantly higher prevalence of all microvascular complications and ischemic heart disease (p<0.001) compared to those with a Fib-4<1.3. There was no significant difference in HbA1c, arterial hypertension, metabolic syndrome, and dyslipidemia. However, the mean LDL-cholesterol was lower in the group with a Fib-4≥1.3 (p:0.024). Liver ultrasonography showed signs of metabolic dysfunction-associated steatotic liver disease in 47.7% of cases.

Conclusion. Fibrosis-4 index should be considered for routine screening of liver fibrosis in patients with type 2 diabetes mellitus. This simple and cost-effective tool can help identify patients at high risk. The current study highlighted the benefits of using this score among patients with T2DM and supported the high prevalence of microvascular complications and ischemic heart disease among patients with Fib-4 index ≥1.3. Furthermore prospective studies are required to evaluate the incidence outcomes in this population.