Clinical utility of noninvasive scores in assessing advanced hepatic fibrosis in patients with type 2 diabetes mellitus: a study in biopsy-proven non-alcoholic fatty liver disease.

Alkayyali T., Qutranji L., Kaya E., Bakir A., Yilmaz Y.

Acta diabetologica, 2020 (Peer-Reviewed Journal) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume:
  • Publication Date: 2020
  • Doi Number: 10.1007/s00592-019-01467-7
  • Journal Name: Acta diabetologica
  • Journal Indexes: Science Citation Index Expanded, Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Keywords: Non-alcoholic fatty liver disease, Fibrosis scores, Advanced fibrosis, Type 2 diabetes mellitus, Screening, SCORING SYSTEM, NAFLD, DIAGNOSIS



Simple noninvasive fibrosis scores based on routine blood tests have been increasingly investigated as screening tools in different clinical settings. Here, we sought to examine whether the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) could perform differently in diabetic versus non-diabetic patients with biopsy-proven NAFLD.


We examined 349 patients with biopsy-proven NAFLD (166 with type 2 diabetes and 183 without). Patients with FIB-4 scores < 1.3 and  > 2.67 or NFS scores < - 1.455 and  > 0.676 were considered at low and high risk of advanced fibrosis, respectively.


A FIB-4 cutoff value of 1.3-which denotes a low risk of advanced fibrosis-had a specificity of 67% in patients with diabetes and 69% in those without. Conversely, a FIB-4 cutoff value of 2.67-which denotes a high risk of advanced fibrosis-had a sensitivity of 22% in patients with diabetes and 0% in those without. NFS performed similar to FIB-4.


Both FIB-4 and NFS scores have an acceptable clinical utility in the exclusion of advanced fibrosis in patients with NAFLD, regardless of the presence of type 2 diabetes. However, their usefulness in identifying advanced fibrosis is limited-especially in the absence of diabetes.