Article Dans Une Revue Diabetes Care Année : 2025

Screening for Metabolic Dysfunction–Associated Steatotic Liver Disease–Related Advanced Fibrosis in Diabetology: A Prospective Multicenter Study

1 CRNH-RA - Centre de Recherche en Nutrition Humaine Rhône-Alpes
2 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
3 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
4 CTM - Center for Translational and Molecular medicine [Dijon - UMR1231]
5 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
6 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer
7 ImmunoConcept - Immunology from Concept and Experiments to Translation = Immunologie Conceptuelle, Expérimentale et Translationnelle
8 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
9 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer
10 Service d'Endocrinologie, Diabétologie et Maladies Métaboliques (CHU de Dijon)
11 Service d'anesthésie - réanimation chirurgicale [CHU de Dijon]
12 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
13 LBBE - Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
14 Service de Biostatistiques [Lyon]
15 HCL - Hospices Civils de Lyon
16 Département biostatistiques et modélisation pour la santé et l'environnement [LBBE]
17 Biostatistiques santé [LBBE]
18 Hôpital Edouard Herriot [CHU - HCL]
19 CHU Thorax - Institut du Thorax [CHU Nantes]
20 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
21 Hôpital Louis Pradel [CHU - HCL]
22 AMU - Aix Marseille Université
23 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
24 Hôpital de la Croix-Rousse [CHU - HCL]
25 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
26 Service d'Endocrinologie [Nantes]
27 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
Pierre Morcel
  • Fonction : Auteur
Philippe Moulin
Emmanuel Disse
  • Fonction : Auteur

Résumé

OBJECTIVE Screening for advanced fibrosis (AF) resulting from metabolic dysfunction–associated steatotic liver disease (MASLD) is recommended in diabetology. This study aimed to compare the performance of noninvasive tests (NITs) with that of two-step algorithms for detecting patients at high risk of AF requiring referral to hepatologists. RESEARCH DESIGN AND METHODS We conducted a planned interim analysis of a prospective multicenter study including participants with type 2 diabetes and/or obesity and MASLD with comprehensive liver assessment comprising blood-based NITs, vibration-controlled transient elastography (VCTE), and two-dimensional shear-wave elastography (2D-SWE). AF risk stratification was determined by a composite criterion of liver biopsy, magnetic resonance elastography, or VCTE ≥12 kPa depending on availability. RESULTS Of 654 patients (87% with type 2 diabetes, 56% male, 74% with obesity), 17.6% had an intermediate/high risk of AF, and 9.3% had a high risk of AF. The area under the empirical receiver operating characteristic curves of NITs for detection of high risk of AF were as follows: Fibrosis-4 (FIB-4) score, 0.78 (95% CI 0.72–0.84); FibroMeter, 0.74 (0.66–0.83); Fibrotest, 0.78 (0.72–0.85); Enhanced Liver Fibrosis (ELF) test, 0.82 (0.76–0.87); and SWE, 0.84 (0.78–0.89). Algorithms with FIB-4 score/VCTE showed good diagnostic performance for referral of patients at intermediate/high risk of AF to specialized care in hepatology. An alternative FIB-4 score/ELF test strategy showed a high negative predictive value (NPV; 88–89%) and a lower positive predictive value (PPV; 39–46%) at a threshold of 9.8. The FIB-4 score/2D-SWE strategy had an NPV of 91% and a PPV of 58–62%. The age-adapted FIB-4 score threshold resulted in lower NPVs and PPVs in all algorithms. CONCLUSIONS The FIB-4 score/VCTE algorithm showed excellent diagnostic performance, demonstrating its applicability for routine screening in diabetology. The ELF test using an adapted low threshold at 9.8 may be used as an alternative to VCTE.

Dates et versions

hal-04960277 , version 1 (21-02-2025)

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Citer

Cyrielle Caussy, Bruno Vergès, Damien Leleu, Laurence Duvillard, Fabien Subtil, et al.. Screening for Metabolic Dysfunction–Associated Steatotic Liver Disease–Related Advanced Fibrosis in Diabetology: A Prospective Multicenter Study. Diabetes Care, 2025, 48 (6), ⟨10.2337/dc24-2075⟩. ⟨hal-04960277⟩
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