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Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis

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Ioan Sporea1, Ruxandra Mare1, Raluca Lupușoru1, Alexandra Sima2, Roxana Șirli1, Alina Popescu1, Romulus Timar2

1) Department of Gastroenterology and Hepatology,
2) Department of Metabolic Diseases, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.252.lsf

Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. The aim of our study was to evaluate a population of diabetic patients regarding the severity of liver steatosis and liver fibrosis.

Methods: The study included 392 type 2 diabetic patients prospectively randomized, evaluated in the same session by transabdominal ultrasound to assess steatosis and by liver elastography to assess fibrosis (Transient Elastography – TE, FibroScan, EchoSens). Steatosis severity was graded using a semi-quantitative scale (S0-no steatosis; S1-mild steatosis; S2-moderate steatosis; S3-severe steatosis). For differentiation between stages of liver fibrosis, the following cut-off values were used (Wong et al., 2010): F2-F3: 7-10.2kPa, F4≥10.3 kPa.

Results: Reliable elastographic measurements were obtained in 76% (298/392) patients. By using the proposed cut-off values, significant fibrosis (F2-F3) was found in 18.8% (56) patients with steatosis, while 13.8% (41) had cirrhosis (F4). Significant fibrosis (F2-F3) was found in 20.4% (20/98) of the patients with S1, in 18.6% (22/118) of those with S2 and in 31.8% (14/44) of those with S3, while cirrhosis (F4) was diagnosed in 7.1% (7/98) patients with S1, in 20.3% (24/118) of those with S2 and in 22.7% (10/44) of those with S3.

Conclusions: Liver steatosis diagnosed by ultrasound is very frequently found in type 2 diabetes mellitus patients, more than half of them having moderate/severe steatosis. A significant liver stiffness increase was found in more than 30% of these patients. Liver stiffness assessment in type 2 diabetic patients should be performed systematically to identify those with significant liver fibrosis.

Key words: diabetes mellitus – liver steatosis – liver stiffness – liver fibrosis – Transient Elastography.

Abbreviations: 2D-SWE: Two Dimensional Shear Waves Elastography; ALT: alanine aminotransferase; AP: alkaline phosphatase; ARFI: Acoustic Radiation Force Impulse; AST: aspartate aminotransferase; AUROC: area under the receiver operating characteristic; BMI: body mass index; DM: diabetes mellitus; GGT: gammaglutamyl transpeptidase; HbA1c: glycated hemoglobin; HBsAg: hepatitis B virus surface antigen; HBV: hepatitis B virus; HCV: hepatitis C virus; LC: liver cirrhosis; LS: liver stiffness; NAFLD: nonalcoholic fatty liver disease; NASH: nonalcoholic steatohepatitis; TE: transient elastography; US: ultrasound.