We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Non‐invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh type 2 diabetes study.
- Authors
Grecian, Sheila M.; McLachlan, Stela; Fallowfield, Jonathan A.; Kearns, Patrick K. A.; Hayes, Peter C.; Guha, Neil I.; Morling, Joanne R.; Glancy, Stephen; Williamson, Rachel M.; Reynolds, Rebecca M.; Frier, Brian M.; Zammitt, Nicola N.; Price, Jackie F.; Strachan, Mark W. J.
- Abstract
Background: The incidence of cirrhosis and hepatocellular carcinoma (HCC) is increased in Type 2 diabetes, primarily secondary to non‐alcoholic fatty liver disease (NAFLD). European guidelines recommend screening for NAFLD in Type 2 diabetes. American guidelines, while not advocating a screening protocol, suggest using non‐invasive markers of fibrosis for risk‐stratification and guiding onward referral. Aims: To test the ability of individual fibrosis scores and the European screening algorithm to predict 11‐year incident cirrhosis/HCC in an asymptomatic community cohort of older people with Type 2 diabetes. Methods: The Edinburgh Type 2 Diabetes Study investigated men and women with Type 2 diabetes (n = 1066, aged 60–75 at baseline). Liver markers were measured at baseline and year 1; steatosis and fibrosis markers were calculated according to independently published calculations. During 11 years of follow‐up, cases of cirrhosis and HCC were identified. Results: Forty‐three out of 1059 participants with no baseline cirrhosis/HCC developed incident disease. All scores were significantly associated with incident liver disease by odds ratio (P <.05). The ability of the risk‐stratification tools to accurately identify those who developed incident cirrhosis/HCC was poor with low‐positive predictive values (5‐46%) and high false‐negative and ‐positive rates (up to 60% and 77%) respectively. When fibrosis risk scores were used in conjunction with the European algorithm, they performed modestly better than when applied in isolation. Conclusions: In a cohort with a moderately low incidence of cirrhosis/HCC, existing risk scores did not reliably identify participants at high risk. Better prediction models for cirrhosis/HCC in people with Type 2 diabetes are required.
- Subjects
TYPE 2 diabetes; FATTY liver; CIRRHOSIS of the liver; DIABETES in women
- Publication
Liver International, 2020, Vol 40, Issue 9, p2252
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.14590