Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh Type 2 Diabetes Study

Autor: Peter C. Hayes, Stela McLachlan, Patrick K. A. Kearns, Jackie F. Price, Mark W. J. Strachan, Jonathan A. Fallowfield, Joanne R Morling, Neil Guha, Sheila M. Grecian, Rachel M. Williamson, Brian M. Frier, Rebecca M. Reynolds, S Glancy, Nicola N. Zammitt
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Grecian, S, McLachlan, S, Fallowfield, J A, Kearns, P, Hayes, P C, Guha, I N, Morling, J, Glancy, S, Williamson, R M, Reynolds, R M, Frier, B, Zammitt, N N, Price, J F & Strachan, M 2020, ' Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh Type 2 Diabetes Study ', Liver International . https://doi.org/10.1111/liv.14590
DOI: 10.1111/liv.14590
Popis: 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.
Databáze: OpenAIRE
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