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Addition of hyaluronic acid to the FIB-4 liver fibrosis score improves prediction of incident cirrhosis and hepatocellular carcinoma in type 2 diabetes: The Edinburgh Type 2 Diabetes Study. | LitMetric

AI Article Synopsis

  • Type 2 diabetes (T2D) increases the risk of developing cirrhosis and hepatocellular carcinoma (HCC), especially in individuals with non-alcoholic fatty liver disease (NAFLD), but the overall risk is low, making accurate patient identification essential for effective management.
  • The Edinburgh Type 2 diabetes Study (ET2DS) evaluated existing risk-stratification tools and tested the addition of biomarkers like hyaluronic acid to improve the prediction of cirrhosis and HCC in T2D patients over 11 years.
  • Findings showed that combining hyaluronic acid with the FIB-4 index significantly reduced the number of people incorrectly labeled as high-risk for cirrhosis/HCC, suggesting

Article Abstract

Background: Type 2 diabetes (T2D) is associated with increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC) in people with chronic liver diseases, particularly non-alcoholic fatty liver disease (NAFLD). However, the absolute risk of progression is low. So, it is crucial to accurately identify patients who would benefit most from hepatology referral and intensified management. Current risk-stratification tools are suboptimal and perform worse in people with diabetes.

Aims: To determine whether the addition of complementary biomarker(s) to current NAFLD risk-stratification tools in people with T2D could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC.

Methods: The Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with T2D ( = 1066, age 60-75 at baseline). Cases of cirrhosis and HCC were identified over 11 years of follow-up. Biomarkers were measured at baseline and year 1 and association with incident disease was assessed using logistic regression.

Results: Of existing risk-stratification scores tested, the Fibrosis-4 (FIB-4) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut-point ≥ 50   g/L) to FIB-4 (cut-point ≥ 1.3) maintained a false negative rate of ≤25% and reduced the number of people incorrectly identified as "high risk" for incident disease by ∼50%.

Conclusions: The addition of hyaluronic acid to FIB-4 reduced the proportion of people inappropriately identified as "high risk" for development of cirrhosis/HCC in a community population of otherwise asymptomatic people with T2D. These findings require a validation in independent cohorts.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488456PMC
http://dx.doi.org/10.1002/osp4.484DOI Listing

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