title: Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: the Edinburgh type 2 diabetes study.
abstract: OBJECTIVE
  It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research.
  
  
  METHODS
  In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured.
  
  
  RESULTS
  Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%).
  
  
  CONCLUSIONS
  We found poor correlation between the five biomarkers of liver fibrosis studied. Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease but poor agreement on the presence of advanced disease. Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints, in a range of different low and high risk population groups.
authors: Joanne R
authors: JR
authors: Morling
authors: Jonathan A
authors: JA
authors: Fallowfield
authors: Indra N
authors: IN
authors: Guha
authors: Lisa D
authors: LD
authors: Nee
authors: Stephen
authors: S
authors: Glancy
authors: Rachel M
authors: RM
authors: Williamson
authors: Christine M
authors: CM
authors: Robertson
authors: Mark W J
authors: MW
authors: Strachan
authors: Jackie F
authors: JF
authors: Price
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D010976:Platelet Count; D011237:Predictive Value of Tests; D012606:Scotland
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase