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.

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 (

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 

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.

Informations de copyright

© 2021 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

Déclaration de conflit d'intérêts

Jonathan A. Fallowfield has served as a consultant or advisory board member for Novartis, Ferring Pharmaceuticals, Macrophage Pharma, Aquilla BioMedical, Galecto Biotech, Caldan Therapeutics, Cypralis, NorthSea Therapeutics, Rallybio, Tectonic, and has received research funding from Novartis and Intercept Pharmaceuticals, outside the submitted work. Peter C. Hayes has served as speaker or on advisory boards for the following AbbVie, BMS, Eisai Ltd, Falk, Ferring, Gilead, Gore, Janssen, Lundbeck, MSD, Norgine, Novartis, ONO Pharmaceuticals, Pfizer and Roche. Joanne R. Morling reports salary support from Diabetes UK for the ET2DS. Rachel M. Williamson reported salary funding by a research grant from Pfizer for 2 years. Brian M. Frier has participated in a Speakers' Bureau for: Lilly, Novo Nordisk, MSD, Sanofi, Roche, and Abbott and has served on advisory boards for Lilly, and Zucara. Mark W.J. Strachan has received consultancy fees from Servier and Novo Nordisk and speaking fees from Napp, Sanofi, Astra Zenica, Merck and Eli Lilly. No other potential conflicts of interest relevant to this article were reported.