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Abstract Details
Current NAFLD guidelines for risk stratification in diabetic patients have poor diagnostic discrimination
Sci Rep. 2020 Oct 27;10(1):18345. doi: 10.1038/s41598-020-75227-x.
Valentin Blank12, David Petroff23, Sebastian Beer1, Albrecht Böhlig4, Maria Heni1, Thomas Berg4, Yvonne Bausback5, Arne Dietrich26, Anke Tönjes7, Marcus Hollenbach1, Matthias Blüher27, Volker Keim1, Johannes Wiegand4, Thomas Karlas8
Author information
1Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
2Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany.
3Clinical Trial Centre Leipzig, University of Leipzig, Härtelstraße 16/18, 04107, Leipzig, Germany.
4Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
5Division of Angiology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
6Division of Visceral, Transplantation, Thorax and Vascular Surgery, Section of Bariatric Surgery, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
7Division of Endocrinology and Nephrology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
8Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany. thomas.karlas@medizin.uni-leipzig.de.
Abstract
Patients with type 2 diabetes (T2D) are at risk for non-alcoholic fatty liver disease (NAFLD) and associated complications. This study evaluated the performance of international (EASL-EASD-EASO) and national (DGVS) guidelines for NAFLD risk stratification. Patients with T2D prospectively underwent ultrasound, liver stiffness measurement (LSM) and serum-based fibrosis markers. Guideline-based risk classification and referral rates for different screening approaches were compared and the diagnostic properties of simplified algorithms, genetic markers and a new NASH surrogate (FAST score) were evaluated. NAFLD risk was present in 184 of 204 screened patients (age 64.2 ± 10.7 years; BMI 32.6 ± 7.6 kg/m2). EASL-EASD-EASO recommended specialist referral for 60-77% depending on the fibrosis score used, only 6% were classified as low risk. The DGVS algorithm required LSM for 76%; 25% were referred for specialised care. The sensitivities of the diagnostic pathways were 47-96%. A simplified referral strategy revealed a sensitivity/specificity of 46/88% for fibrosis risk. Application of the FAST score reduced the referral rate to 35%. This study (a) underlines the high prevalence of fibrosis risk in T2D, (b) demonstrates very high referral rates for in-depth hepatological work-up, and (c) indicates that simpler referral algorithms may produce comparably good results and could facilitate NAFLD screening.