Diagnostic Performance of Non-Invasive Tests in Assessing Liver Fibrosis Among Type 2 Diabetes Mellitus
Keywords:
Type 2 Diabetes Mellitus, fibrosis, non-alcoholic fatty liver disease (NAFLD), Liver cirrhosis, Diagnostic accuracyAbstract
Background: Noninvasive tools for assessing liver fibrosis are essential, especially in patients with Type 2 Diabetes Mellitus (T2DM) who are at high risk of developing metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to evaluate the correlation between the diagnostic accuracy of the Fibrosis-4 Index (FIB-4), aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS) and the diagnostic accuracy of FibroScan® in Indonesian patients with T2DM. Methods: This cross-sectional study enrolled 80 outpatients with T2DM. Liver fibrosis was evaluated using FibroScan®. FIB-4, APRI, and NFS were calculated using routine clinical and laboratory parameters. Correlations between noninvasive scores and liver stiffness measurement (LSM) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance for significant fibrosis (≥F2) and cirrhosis (F3-F4). Results: MAFLD was present in 67.5% of subjects; significant fibrosis and cirrhosis were found in 25% and 7.5% of subjects, respectively. FIB-4 and NFS showed significant correlations with LSM (ρ = 0.291 and 0.296; p < 0.01), whereas APRI did not. FIB-4, APRI, and NFS demonstrated fair to good diagnostic performance for significant fibrosis (area under the curve (AUC) 0.693, 0.685, 0.693) and excellent performance for cirrhosis (AUC 0.825, 0.860, 0.870). Female sex and HOMA-IR were independent predictors of significant fibrosis; AST and platelet count were predictive of cirrhosis. Conclusion: FIB-4, APRI, and NFS are effective and affordable screening tools for initial fibrosis in patients with T2DM, particularly in low-resource settings. The combination of these measures may enhance the detection of at-risk individuals for referral and further management.References
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Copyright (c) 2026 Annisa Zahra Mufida, Amal Arifi Hidayat, Ricky Indra Alfaray, Ulfa Kholili, Sony Wibisono, Titong Sugihartono, Nurike Setiyari Mudjari, Robert Dwitama Adiwinoto, Febri Kurniawati, Muhammad Miftahussurur
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