PMID- 35486350
OWN - NLM
STAT- MEDLINE
DCOM- 20230404
LR  - 20230404
IS  - 1863-4362 (Electronic)
IS  - 0021-1265 (Linking)
VI  - 192
IP  - 2
DP  - 2023 Apr
TI  - Reduced and more appropriate referrals of patients with type 2 diabetes using 
      liver stiffness measurement compared to FIB-4.
PG  - 649-654
LID - 10.1007/s11845-022-03019-5 [doi]
AB  - BACKGROUND: Fatty liver disease and fibrosis are common in patients with type 2 
      diabetes mellitus (T2DM). Recently published European Association for the Study 
      of the Liver guidelines have suggested screening such patients using liver 
      stiffness measurement (LSM) or fibrosis-4 index (FIB-4) to exclude advanced 
      fibrosis. AIMS: We initiated a screening programme at the diabetes out-patient 
      clinic to assess the reliability of the suggested approaches and resulting 
      referrals. METHODS: In this prospective study, consecutive patients attending for 
      T2DM review at an Irish level 3 (district general) hospital between September and 
      November 2021 were screened for liver fibrosis using LSM and had their FIB-4 
      calculated. The first 100 patients with valid LSM measurements were included in 
      the analysis. RESULTS: Referral rates to the hepatology clinic varied by modality 
      used. If FIB-4 >/= 1.3 criterion was used, the referral rate to the hepatology 
      clinic was 45%; using LSM < 8 kPa to rule out advanced fibrosis resulted in 34% 
      referral rate; using LSM >/= 10 kPa to suggest probable compensated advanced 
      chronic liver disease reduced referral rates to 15%. Combining FIB-4 with LSM in 
      a two-step algorithm led to missed potentially significant liver disease in large 
      numbers. 47% patients with LSM >/= 8 kPa and 33% with LSM >/= 10 kPa had FIB-4 < 1.3. 
      CONCLUSIONS: Screening of patients with T2DM using LSM alone rather than FIB-4 
      leads to reduced numbers of, and more appropriate, referrals to the hepatology 
      clinic. Shifting from an exclusion (LSM < 8 kPa) to an inclusion based 
      (LSM >/= 10 kPa) approach may lessen the potential of screening to overwhelm 
      hepatology services.
CI  - (c) 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in 
      Ireland.
FAU - Shanahan, William
AU  - Shanahan W
AUID- ORCID: 0000-0001-6146-2928
AD  - Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co 
      Tipperary, Ireland. shanahaw@tcd.ie.
FAU - Bagwe, Isha
AU  - Bagwe I
AD  - Department of Endocrinology, Tipperary University Hospital, Clonmel, Co 
      Tipperary, Ireland.
FAU - Brassill, Mary Jane
AU  - Brassill MJ
AD  - Department of Endocrinology, Tipperary University Hospital, Clonmel, Co 
      Tipperary, Ireland.
FAU - O'Regan, Paud
AU  - O'Regan P
AD  - Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co 
      Tipperary, Ireland.
LA  - eng
PT  - Journal Article
DEP - 20220429
PL  - Ireland
TA  - Ir J Med Sci
JT  - Irish journal of medical science
JID - 7806864
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 2/complications/pathology
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Predictive Value of Tests
MH  - *Elasticity Imaging Techniques
MH  - Liver/pathology
MH  - Liver Cirrhosis/diagnostic imaging/pathology
OTO - NOTNLM
OT  - FIB-4
OT  - Fibrosis
OT  - Liver stiffness
OT  - NAFLD
OT  - Screening
OT  - Type 2 diabetes
EDAT- 2022/04/30 06:00
MHDA- 2023/04/04 06:42
CRDT- 2022/04/29 11:22
PHST- 2022/01/24 00:00 [received]
PHST- 2022/04/22 00:00 [accepted]
PHST- 2023/04/04 06:42 [medline]
PHST- 2022/04/30 06:00 [pubmed]
PHST- 2022/04/29 11:22 [entrez]
AID - 10.1007/s11845-022-03019-5 [pii]
AID - 10.1007/s11845-022-03019-5 [doi]
PST - ppublish
SO  - Ir J Med Sci. 2023 Apr;192(2):649-654. doi: 10.1007/s11845-022-03019-5. Epub 2022 
      Apr 29.