A Hospital Based Observational Study to Detect Non-Alcoholic Steatohepatitis by Acoustic Radiation Force Impulse in Individuals with Diabetes Mellitus and Metabolic Syndrome.

Abstract

Non-alcoholic fatty liver disease (NAFLD)/ non-alcoholic steatohepatitis (NASH) is a rising epidemic with a potential for life threatening complications, especially in individuals with diabetes mellitus (DM) and metabolic syndrome. Though liver biopsy remains the recommended gold standard for diagnosing liver fibrosis, due to its technical feasibility and requirement of trained personnel, methods to develop non-invasive diagnostic tools for liver fibrosis have recently been underway. One such non-invasive method to diagnose liver fibrosis, point shear wave elastography using Acoustic Radiation Force Impulse (ARFI)-Imaging has gained remarkable results. This research was carried out to assess non-alcoholic steatohepatitis by acoustic radiation force impulse in individuals with diabetes and metabolic syndrome. Between March 2020 and October 2021, 140 patients with DM and metabolic syndrome, were identified. Demographic profile as well as reports of complete blood count, liver function tests, renal function tests, serum lipid profile, fasting blood sugar and postprandial blood sugar of the study participants were collected and recorded. Point shear wave liver elastography using ARFI imaging was performed for each of the study participant. NAFLD fibrosis score was determined in all of the study participants using appropriate software. Continuous and categorical variables were expressed as mean ± standard deviation and percentages respectively. Two-sided p values were considered as statistically significant at p value <0.05. Chi square test was done to see the association of clinical symptoms with fibrosis or non fibrosis. Independent t test was done to compare test variables and lab parameters between fibrosis and no fibrosis. Among the 140 study participants, 83 were males (59.29%) and 57 were (40.71%) females. On analysing the mean velocities measured by using ARFI elastography,30 participants (21.43%) had mean velocities >2.2m/s suggesting the presence of liver fibrosis and 110(78.57%) participants had mean velocities <2.2m/s did not have fibrosis. Among 83 males, 20(24.1%) had fibrosis and among 57 females, 10(17.5%) had fibrosis (p>0.05). Mean age of the 'Fibrosis' group was 54.53 (SD12.42) and that of the 'No fibrosis' group was 56.20(SD 11.76). Majority of the participants were between 56 and 65 years of age (50 participants). The mean height, weight and BMI of the 'Fibrosis' group was 152.84(±41.29), 73.33(±8.41), and 27.37(±2.73) respectively and that of the 'No fibrosis' group was 157.31(26.47), 70.89(12.46) and, 27.10(4.22) respectively (p>0.05). In the 'Fibrosis' group, majority (60%) were in the Obese 1 group and in the 'No fibrosis' group as well, majority were in the Obese 1 group (47.3%) (p=0.286). The mean (±SD) NAFLD- fibrosis Score was -1.54±1.06 in the 'No fibrosis' group and -0.61±1.81 in the 'Fibrosis' group (p value=0.012). There was no significant difference between fasting blood sugar, postprandial blood sugar, triglyceride and HbA1c levels among the 'Fibrosis' and 'No Fibrosis' groups. Among the 2 groups, there was no statistically significant difference between waist circumference, presence of hypertension, dyslipidaemia or other co-morbidities, in our study. None of the 30 individuals in the 'Fibrosis' group were on insulin (p=0.032), showing a significant difference in insulin usage among the 2 groups. There were significantly higher mean values of NAFLD-Fibrosis score in the individuals with fibrosis as compared to those with no fibrosis (p<0.05). NAFLD, diabetes mellitus and metabolic syndrome are part of the same spectrum. Individuals with diabetes mellitus and metabolic syndrome have a higher risk of developing liver fibrosis. Though in our study, parameters such as age, gender, hypertension, deranged blood sugars and lipid profile values were not significantly associated with liver fibrosis, NAFLD fibrosis score was found to have a significant association with liver fibrosis in these individuals.