OBJECTIVE Fatty liver disease (FLD) is prevalent in diabetes, and both disproportionately affect vulnerable populations. The FIB-4 index is recommended to screen for advanced liver fibrosis. Limited data have suggested that diabetes may impact FIB-4. RESEARCH DESIGN AND METHODS We evaluated FIB-4 accuracy for advanced fibrosis compared with liver biopsy in the presence of diabetes and obesity. RESULTS Among 363 FLD patients receiving care in San Francisco’s safety net health care system from August 2009 to February 2020, characteristics were as follows: median age 51 years, 46% male, 59% Hispanic, 68% obese, 33% with diabetes, and 31% with advanced fibrosis on histology. Overall, the c-statistic for FIB-4 was 0.79, but was worse in patients with diabetes, 0.68, than without, 0.85 (P = 0.003). Accuracy also varied by weight, at 0.65, 0.85, and 0.75 for normal weight, overweight, and obese, respectively, although not significantly (P = 0.24). CONCLUSIONS The findings highlight limitations of FIB-4 in screening for advanced liver fibrosis, particularly in individuals with diabetes.

中文翻译：

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弱势人群脂肪肝疾病的无创纤维化筛查：糖尿病和肥胖对 FIB-4 评分准确性的影响

目的 脂肪肝病 (FLD) 在糖尿病中很常见，并且两者对弱势群体的影响都不成比例。建议使用FIB-4指数筛查晚期肝纤维化。有限的数据表明糖尿病可能会影响 FIB-4。研究设计和方法 我们在患有糖尿病和肥胖的情况下，与肝活检相比，评估了 FIB-4 对晚期纤维化的准确性。结果 2009 年 8 月至 2020 年 2 月期间，在旧金山安全网医疗保健系统中接受护理的 363 名 FLD 患者中，特征如下：中位年龄 51 岁，46% 为男性，59% 为西班牙裔，68% 肥胖，33% 患有糖尿病， 31% 的组织学表现为晚期纤维化。总体而言，FIB-4 的 c 统计值为 0.79，但患有糖尿病的患者为 0.68，比没有糖尿病的患者为 0.85（P = 0.003）。准确度也因体重而异，正常体重、超重和肥胖的准确度分别为 0.65、0.85 和 0.75，但差异不显着 (P = 0.24)。结论 这些发现强调了 FIB-4 在筛查晚期肝纤维化方面的局限性，特别是在糖尿病患者中。