The association between glycemic state, R factor and Steatosis-Associated Fibrosis Estimator score in advanced liver fibrosis in patients with diabetes mellitus

Abstract

Aims

R factor and Steatosis-Associated Fibrosis Estimator (SAFE) score utilized to evaluate the connection between them and glycemic control and non-invasive tests in liver fibrosis among patients with diabetes mellitus (DM).

Methods

The 2017–2018 National Health and Nutrition Examination Survey (NHANES) database was used and participants with DM or those with glycohemoglobin levels of 6.5% or higher were included. The R factor, the SAFE score, FIB-4, FIB-8, Fatty Liver Index (FLI), Hepatic steatosis index (HSI), Glycemic Risk Assessment in Diabetes Equation (GRADE), McAuley's Index, and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated for each participant. The Pearson's correlation and area under the receiver operating characteristic (AUROC) curve were utilized.

Results

Among 885 diabetic participants, the SAFE score had a moderate correlation with liver stiffness (r = 0.34, p < 0.0001) and weak correlation with CAP (r = 0.11, p = 0.0011). The R factor demonstrated weaker correlations with liver fibrosis markers. The SAFE score strongly correlated with FIB-4 and FIB-8 (both r = 0.78, p < 0.0001). Glycemic markers showed mixed correlations with SAFE score and R factor. The SAFE score demonstrated good accuracy (AUROC = 0.717, 95% confidence interval: 0.667–0.768) in detecting advanced liver fibrosis in diabetic subjects, outperforming other non-invasive tests.

Conclusion

The SAFE score and R factor correlate with liver fibrosis markers in diabetic patients, with the SAFE score showing slightly stronger associations. The complex relationships between glycemic state markers and liver fibrosis indices suggest that liver health in diabetic patients may not be directly proportional to current glycemic control.