PMID- 35288342
OWN - NLM
STAT- MEDLINE
DCOM- 20230425
LR  - 20230507
IS  - 1542-7714 (Electronic)
IS  - 1542-3565 (Linking)
VI  - 21
IP  - 5
DP  - 2023 May
TI  - Impact of Type 2 Diabetes on the Accuracy of Noninvasive Tests of Liver Fibrosis 
      With Resulting Clinical Implications.
PG  - 1243-1251.e12
LID - S1542-3565(22)00248-8 [pii]
LID - 10.1016/j.cgh.2022.02.059 [doi]
AB  - BACKGROUND & AIMS: Noninvasive tests (NITs) of liver fibrosis have been suggested 
      to be less accurate in type 2 diabetes mellitus (T2DM). We aimed to compare the 
      accuracy of 6 NITs between patients with or without T2DM, explain any 
      differences, and adapt diagnostic algorithms for clinical practice accordingly. 
      METHODS: We included 1051 patients with nonalcoholic fatty liver disease with 
      liver biopsy, blood fibrosis tests (Nonalcoholic Fatty Liver Disease Fibrosis 
      Score, FIB4, Fibrotest, FibroMeter), vibration-controlled transient elastography 
      (VCTE), and the combinatory elasto-blood test FibroMeter(VCTE). The study 
      endpoint was advanced fibrosis on liver biopsy. RESULTS: NIT areas under the 
      receiver operating characteristic curve were significantly lower in patients with 
      T2DM, mostly because of a decrease in specificity. For FIB4, this decrease in 
      specificity was only related to the higher age of patients with T2DM enrolled. 
      For Fibrotest, FibroMeter, and FibroMeter(VCTE), the decrease in specificity was 
      related to age but also to higher alpha2-macroglobulin level, which is known to 
      increase in T2DM. Sensitivity was unaffected by T2DM, but it masked a doubled raw 
      number of false negatives because of the 2-fold higher prevalence of advanced 
      fibrosis in that setting. The sequential algorithm FIB4-vibration-controlled 
      transient elastography had 90.3% accuracy in patients without T2DM vs 79.0% in 
      those with (P < .001). Algorithms using first-line specialized tests maintained a 
      low rate of false negatives and false positives in T2DM. CONCLUSIONS: The 
      decrease in NIT accuracy observed in T2DM is partly biased by the different 
      characteristics of the groups studied, but also linked to T2DM itself through 
      modification of the levels of some NIT biomarkers. Specialized tests should be 
      used first-line to diagnose advanced liver fibrosis in T2DM.
CI  - Copyright (c) 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Boursier, Jerome
AU  - Boursier J
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France. Electronic address: JeBoursier@chu-angers.fr.
FAU - Canivet, Clemence M
AU  - Canivet CM
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France.
FAU - Costentin, Charlotte
AU  - Costentin C
AD  - Hepato-Gastroenterology Department, Grenoble Alpes University Hospital, Grenoble, 
      France; Institute for Advanced Biosciences, Research Center UGA/Inserm U 
      1209/CNRS 5309, University Grenoble Alpes, Grenoble, France.
FAU - Lannes, Adrien
AU  - Lannes A
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France.
FAU - Delamarre, Adele
AU  - Delamarre A
AD  - Hepatology Unit, Haut Leveque Hospital, Bordeaux University Hospital, Bordeaux, 
      France.
FAU - Sturm, Nathalie
AU  - Sturm N
AD  - Pathology Department, Grenoble Alpes University Hospital, Grenoble, France.
FAU - Le Bail, Brigitte
AU  - Le Bail B
AD  - Pathology Department, Bordeaux University Hospital, Bordeaux, France.
FAU - Michalak, Sophie
AU  - Michalak S
AD  - HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, France; 
      Pathology Department, Angers University Hospital, Angers, France.
FAU - Oberti, Frederic
AU  - Oberti F
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France.
FAU - Hilleret, Marie-Noelle
AU  - Hilleret MN
AD  - Hepato-Gastroenterology Department, Grenoble Alpes University Hospital, Grenoble, 
      France.
FAU - Irles-Depe, Marie
AU  - Irles-Depe M
AD  - Hepatology Unit, Haut Leveque Hospital, Bordeaux University Hospital, Bordeaux, 
      France.
FAU - Fouchard, Isabelle
AU  - Fouchard I
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France.
FAU - Hermabessiere, Paul
AU  - Hermabessiere P
AD  - Hepatology Unit, Haut Leveque Hospital, Bordeaux University Hospital, Bordeaux, 
      France.
FAU - Barthelon, Justine
AU  - Barthelon J
AD  - Hepato-Gastroenterology Department, Grenoble Alpes University Hospital, Grenoble, 
      France.
FAU - Cales, Paul
AU  - Cales P
AD  - Hepato-Gastroenterology and Digestive Oncology Department, Angers University 
      Hospital, Angers, France; HIFIH Laboratory UPRES EA3859, SFR 4208, Angers 
      University, Angers, France.
FAU - Cariou, Bertrand
AU  - Cariou B
AD  - University of Nantes, Nantes University Hospital, CNRS, INSERM, Thorax Institute, 
      F-44000 Nantes, France.
FAU - de Ledinghen, Victor
AU  - de Ledinghen V
AD  - Hepatology Unit, Haut Leveque Hospital, Bordeaux University Hospital, Bordeaux, 
      France.
FAU - Roux, Marine
AU  - Roux M
AD  - HIFIH Laboratory UPRES EA3859, SFR 4208, Angers University, Angers, France.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220311
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
RN  - 0 (Biomarkers)
SB  - IM
CIN - Clin Gastroenterol Hepatol. 2023 Feb;21(2):559-560. PMID: 35398570
MH  - Humans
MH  - *Non-alcoholic Fatty Liver Disease/complications/diagnosis
MH  - *Diabetes Mellitus, Type 2/complications/diagnosis
MH  - Liver Cirrhosis/pathology
MH  - Fibrosis
MH  - Biomarkers
MH  - *Elasticity Imaging Techniques/methods
MH  - Biopsy/adverse effects
MH  - Liver/diagnostic imaging/pathology
OTO - NOTNLM
OT  - Fibrosis
OT  - NAFLD
OT  - Noninvasive Tests
OT  - Type 2 Diabetes Mellitus
EDAT- 2022/03/16 06:00
MHDA- 2023/04/25 06:42
CRDT- 2022/03/15 05:42
PHST- 2022/01/11 00:00 [received]
PHST- 2022/02/23 00:00 [revised]
PHST- 2022/02/23 00:00 [accepted]
PHST- 2023/04/25 06:42 [medline]
PHST- 2022/03/16 06:00 [pubmed]
PHST- 2022/03/15 05:42 [entrez]
AID - S1542-3565(22)00248-8 [pii]
AID - 10.1016/j.cgh.2022.02.059 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2023 May;21(5):1243-1251.e12. doi: 
      10.1016/j.cgh.2022.02.059. Epub 2022 Mar 11.