Gian Paolo Caviglia,Arianna Ferro,Roberta D'Ambrosio,Riccardo Perbellini,Pietro Lampertico,Giulia Periti,Luca Valenti,Carlo Ciccioli,Grazia Pennisi,Salvatore Petta,Lucia Brodosi,Maria Letizia Petroni,Francesca Marchignoli,Loris Pironi,Alessandra Sagripanti,Maria Eva Argenziano,Gianluca Svegliati-Baroni,Chiara Rosso,Federica Barutta,Angelo Armandi,Gabriella Gruden,Elisabetta Bugianesi
{"title":"基于纤维化-4和肝硬度测量的2型糖尿病晚期肝病风险筛查护理模式的有效性:来自意大利前瞻性多中心研究的结果","authors":"Gian Paolo Caviglia,Arianna Ferro,Roberta D'Ambrosio,Riccardo Perbellini,Pietro Lampertico,Giulia Periti,Luca Valenti,Carlo Ciccioli,Grazia Pennisi,Salvatore Petta,Lucia Brodosi,Maria Letizia Petroni,Francesca Marchignoli,Loris Pironi,Alessandra Sagripanti,Maria Eva Argenziano,Gianluca Svegliati-Baroni,Chiara Rosso,Federica Barutta,Angelo Armandi,Gabriella Gruden,Elisabetta Bugianesi","doi":"10.14309/ajg.0000000000003493","DOIUrl":null,"url":null,"abstract":"BACKGROUND AIMS\r\nPatients with type 2 diabetes mellitus (T2DM) are at increased risk for metabolic dysfunction-associated steatotic liver disease (MASLD), advanced liver fibrosis, and metabolic dysfunction-associated steatohepatitis (MASH). We evaluated the prevalence and severity of MASLD among patients with T2DM at their first referral to diabetes clinics, and assessed the effectiveness of the 2-tier screening approach by Fibrosis-4 (FIB-4) and vibration-controlled transient elastography (VCTE).\r\n\r\nMETHODS\r\nConsecutive patients with T2DM from six different diabetes clinics were prospectively enrolled. Liver stiffness measurement (LSM) was assessed by VCTE, while liver steatosis by controlled attenuation parameter (CAP) (Fibroscan, Echosens, France). \"At risk MASH\" was assessed by FibroScan-AST (FAST) score.\r\n\r\nRESULTS\r\n800 patients (median age: 59, 53-65 years; males: 485, 60.6%) met the inclusion criteria. Prevalence of liver steatosis (CAP ≥ 248 db/m) was 73.6%. The proportion of patients at medium/high risk of advanced liver fibrosis (LSM ≥ 8.0 kPa) was 16.9%. Patients with \"at risk MASH\" (FAST > 0.67) were 12.0%.A 2-tier screening for advanced liver fibrosis by FIB-4 and VCTE would have led to 70 (8.8%) patients referred to liver clinics with a false-negative rate of 9.6% (n = 77; patients with FIB-4 < 1.3 and LSM ≥ 8.0 kPa). At multivariate analysis, overweight/obesity (OR = 3.13, 95%CI 1.23-7.97) and elevated ALT (OR = 1.91, 95%CI 1.17-3.10) were independently associated with LSM ≥ 8.0 kPa in patients with FIB-4 < 1.3.\r\n\r\nCONCLUSIONS\r\nIn diabetes clinics, the 2-tier screening using FIB-4 and VCTE is effective for the identification of T2DM patients to be referred to hepatologists. VCTE referral may be considered for patients with overweight/obesity and elevated ALT classified as at low risk of advanced liver fibrosis by FIB-4.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of a model of care based on Fibrosis-4 and liver stiffness measurement for the screening of patients with type 2 diabetes mellitus at risk of advanced liver disease: results from an Italian prospective multicentre study.\",\"authors\":\"Gian Paolo Caviglia,Arianna Ferro,Roberta D'Ambrosio,Riccardo Perbellini,Pietro Lampertico,Giulia Periti,Luca Valenti,Carlo Ciccioli,Grazia Pennisi,Salvatore Petta,Lucia Brodosi,Maria Letizia Petroni,Francesca Marchignoli,Loris Pironi,Alessandra Sagripanti,Maria Eva Argenziano,Gianluca Svegliati-Baroni,Chiara Rosso,Federica Barutta,Angelo Armandi,Gabriella Gruden,Elisabetta Bugianesi\",\"doi\":\"10.14309/ajg.0000000000003493\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND AIMS\\r\\nPatients with type 2 diabetes mellitus (T2DM) are at increased risk for metabolic dysfunction-associated steatotic liver disease (MASLD), advanced liver fibrosis, and metabolic dysfunction-associated steatohepatitis (MASH). We evaluated the prevalence and severity of MASLD among patients with T2DM at their first referral to diabetes clinics, and assessed the effectiveness of the 2-tier screening approach by Fibrosis-4 (FIB-4) and vibration-controlled transient elastography (VCTE).\\r\\n\\r\\nMETHODS\\r\\nConsecutive patients with T2DM from six different diabetes clinics were prospectively enrolled. Liver stiffness measurement (LSM) was assessed by VCTE, while liver steatosis by controlled attenuation parameter (CAP) (Fibroscan, Echosens, France). \\\"At risk MASH\\\" was assessed by FibroScan-AST (FAST) score.\\r\\n\\r\\nRESULTS\\r\\n800 patients (median age: 59, 53-65 years; males: 485, 60.6%) met the inclusion criteria. Prevalence of liver steatosis (CAP ≥ 248 db/m) was 73.6%. The proportion of patients at medium/high risk of advanced liver fibrosis (LSM ≥ 8.0 kPa) was 16.9%. Patients with \\\"at risk MASH\\\" (FAST > 0.67) were 12.0%.A 2-tier screening for advanced liver fibrosis by FIB-4 and VCTE would have led to 70 (8.8%) patients referred to liver clinics with a false-negative rate of 9.6% (n = 77; patients with FIB-4 < 1.3 and LSM ≥ 8.0 kPa). At multivariate analysis, overweight/obesity (OR = 3.13, 95%CI 1.23-7.97) and elevated ALT (OR = 1.91, 95%CI 1.17-3.10) were independently associated with LSM ≥ 8.0 kPa in patients with FIB-4 < 1.3.\\r\\n\\r\\nCONCLUSIONS\\r\\nIn diabetes clinics, the 2-tier screening using FIB-4 and VCTE is effective for the identification of T2DM patients to be referred to hepatologists. VCTE referral may be considered for patients with overweight/obesity and elevated ALT classified as at low risk of advanced liver fibrosis by FIB-4.\",\"PeriodicalId\":520099,\"journal\":{\"name\":\"The American Journal of Gastroenterology\",\"volume\":\"22 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American Journal of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14309/ajg.0000000000003493\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14309/ajg.0000000000003493","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Effectiveness of a model of care based on Fibrosis-4 and liver stiffness measurement for the screening of patients with type 2 diabetes mellitus at risk of advanced liver disease: results from an Italian prospective multicentre study.
BACKGROUND AIMS
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for metabolic dysfunction-associated steatotic liver disease (MASLD), advanced liver fibrosis, and metabolic dysfunction-associated steatohepatitis (MASH). We evaluated the prevalence and severity of MASLD among patients with T2DM at their first referral to diabetes clinics, and assessed the effectiveness of the 2-tier screening approach by Fibrosis-4 (FIB-4) and vibration-controlled transient elastography (VCTE).
METHODS
Consecutive patients with T2DM from six different diabetes clinics were prospectively enrolled. Liver stiffness measurement (LSM) was assessed by VCTE, while liver steatosis by controlled attenuation parameter (CAP) (Fibroscan, Echosens, France). "At risk MASH" was assessed by FibroScan-AST (FAST) score.
RESULTS
800 patients (median age: 59, 53-65 years; males: 485, 60.6%) met the inclusion criteria. Prevalence of liver steatosis (CAP ≥ 248 db/m) was 73.6%. The proportion of patients at medium/high risk of advanced liver fibrosis (LSM ≥ 8.0 kPa) was 16.9%. Patients with "at risk MASH" (FAST > 0.67) were 12.0%.A 2-tier screening for advanced liver fibrosis by FIB-4 and VCTE would have led to 70 (8.8%) patients referred to liver clinics with a false-negative rate of 9.6% (n = 77; patients with FIB-4 < 1.3 and LSM ≥ 8.0 kPa). At multivariate analysis, overweight/obesity (OR = 3.13, 95%CI 1.23-7.97) and elevated ALT (OR = 1.91, 95%CI 1.17-3.10) were independently associated with LSM ≥ 8.0 kPa in patients with FIB-4 < 1.3.
CONCLUSIONS
In diabetes clinics, the 2-tier screening using FIB-4 and VCTE is effective for the identification of T2DM patients to be referred to hepatologists. VCTE referral may be considered for patients with overweight/obesity and elevated ALT classified as at low risk of advanced liver fibrosis by FIB-4.