Importance of non-invasive liver fibrosis scores for mortality and complications development in individuals with type 2 diabetes

• Published in: Journal of diabetes and its complications Vol. 35; no. 5; p. 107879
• Main Authors: Leite, Nathalie C., Cardoso, Claudia R.L., Salles, Gil F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021; Elsevier Limited
• Subjects: Age; Aged; Cardiovascular disease; Cardiovascular outcomes; Cohort analysis; Cohort Studies; Cohort study; Creatinine; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Fatty liver; Female; Heart failure; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver diseases; Liver fibrosis scores; Male; Middle Aged; Mortality; Non-alcoholic fatty liver disease; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - mortality; Patients; Peripheral neuropathy; Type 2 diabetes; Cardiovascular outcomes; Type 2 diabetes; Liver fibrosis scores; Non-alcoholic fatty liver disease; Cohort study; Mortality
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2021.107879

To evaluate the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 score (FIB4) as predictors of complications development and mortality in a cohort of type 2 diabetes. 554 type 2 diabetic subjects had NFS and FIB4 calculated at baseline. Multivariate Cox and Poisson analyses evaluated the associations between fibrosis scores and the occurrence of microvascular and cardiovascular complications, and all-cause mortality. According to recommended cut-offs of NFS, 12.8% had advanced fibrosis and 45.9% had absence of advanced fibrosis and of FIB4, 3.8% and 86.1%, respectively. During a median follow-up of 11 years, 217subjects died, 172 had cardiovascular events (CVEs), 184 had renal events, and 139 had retinopathy and 185 neuropathy events. As continuous variables, both scores predicted all-cause mortality: NFS, HR: 1.30 (p = 0.032) and FIB4, HR: 1.24 (p = 0.021); an increased NFS implied in a significant 90% excess risk of mortality, whereas a higher FIB4 in a borderline 69% higher risk. The scores were mainly predictors of mortality in women and for non-cardiovascular deaths. The NFS was a predictor of renal events, mainly for renal function deterioration. The NFS and FIB4 predicted all-cause mortality, particularly in women and for non-cardiovascular causes. The NFS predicted adverse renal outcomes. These liver fibrosis scores may improve stratification risk in individuals with diabetes and NAFLD. •The importance of NFS and FIB4, has not been investigated in type 2 diabetes.•The NFS and FIB4 predicted all-cause mortality in type 2 diabetes.•This association was particularly evident in women and for non-cardiovascular causes.•The NFS was a predictor of renal events: mainly of renal function decline.•The NFS and FIB-4 may improve risk stratification in diabetic individuals with NAFLD.