Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis.
OBJECTIVE
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.
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Ioan
I
Sporea
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Ruxandra
R
Mare
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Raluca
R
Lupușoru
Department of Metabolic Diseases, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Alexandra
A
Sima
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania. roxanasirli@gmail.com.
Roxana
R
Sirli
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Alina
A
Popescu
Department of Metabolic Diseases, Victor Babeș University of Medicine and Pharmacy Timișoara, Romania.
Romulus
R
Timar
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012383:Romania; D012720:Severity of Illness Index