title: Prognostic value of liver fibrosis and steatosis biomarkers in type-2 diabetes and dyslipidaemia.
abstract: BACKGROUND
  In cardiometabolic disorders, non-alcoholic fatty liver disease is frequent and presumably associated with increased mortality and cardiovascular risk.
  
  
  OBJECTIVE
  To evaluate the prognostic value of non-invasive biomarkers of liver fibrosis (FibroTest) and steatosis (SteatoTest) in patients with type-2 diabetes and/or dyslipidaemia.
  
  
  METHODS
  A total of 2312 patients with type-2 diabetes and/or dyslipidaemia were included and prospectively followed up for 5-15 years. The cardiovascular Framingham-risk score was calculated; advanced fibrosis and severe steatosis, were defined by FibroTest >0.48 and SteatoTest >0.69, respectively, as previously established.
  
  
  RESULTS
  During a median follow-up of 12 years, 172 patients (7.4%) died. The leading causes of mortality were cancer (31%) and cardiovascular-related death (20%). The presence of advanced fibrosis [HR (95% CI)] [2.98 (95% CI 1.78-4.99); P < 0.0001] or severe steatosis [1.86 (1.34-2.58); P = 0.0002] was associated with an increased risk of mortality. In a multivariate Cox model adjusted for confounders: the presence of advanced fibrosis was associated with overall mortality [1.95 (1.12-3.41); P = 0.02]; advanced fibrosis at baseline [n = 50/677; 1.92 (1.04-3.55); P = 0.04] and progression to advanced fibrosis during follow-up [n = 16/127; 4.8 (1.5-14.9); P = 0.007] were predictors of cardiovascular events in patients with type-2 diabetes. In patients with a Framingham-risk score ≥20%, the presence of advanced fibrosis was predictive of cardiovascular events [2.24 (1.16-4.33); P < 0.05].
  
  
  CONCLUSIONS
  Liver biomarkers, such as FibroTest and SteatoTest, have prognostic values in patients with metabolic disorders. FibroTest has prognostic value for predicting overall survival in patients with type-2 diabetes and/or dyslipidaemia. In type-2 diabetes, FibroTest predicted cardiovascular events and improved the Framingham-risk score.
authors.affiliation: Hepatology Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), INSERM & Université Pierre et Marie Curie - Univ Paris 06 UMR_S 938, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Perazzo
authors.forename: M
authors.initials: M
authors.lastname: Munteanu
authors.forename: Y
authors.initials: Y
authors.lastname: Ngo
authors.forename: P
authors.initials: P
authors.lastname: Lebray
authors.forename: N
authors.initials: N
authors.lastname: Seurat
authors.forename: F
authors.initials: F
authors.lastname: Rutka
authors.forename: M
authors.initials: M
authors.lastname: Couteau
authors.forename: S
authors.initials: S
authors.lastname: Jacqueminet
authors.forename: P
authors.initials: P
authors.lastname: Giral
authors.forename: D
authors.initials: D
authors.lastname: Monneret
authors.forename: F
authors.initials: F
authors.lastname: Imbert-Bismut
authors.forename: V
authors.initials: V
authors.lastname: Ratziu
authors.forename: A
authors.initials: A
authors.lastname: Hartemann-Huertier
authors.forename: C
authors.initials: C
authors.lastname: Housset
authors.forename: T
authors.initials: T
authors.lastname: Poynard
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers