Increased Prevalence of Advanced Metabolic Dysfunction-Associated Steatotic Liver Disease Fibrosis in Type 2 Diabetics Despite Low-Risk Fibrosis-4 Index Scores
Bibliographic record
Abstract
Background: The American Gastroenterology Association (AGA) guidelines for metabolic dysfunction-associated steatotic liver disease (MASLD) recommend screening for fibrosis in high-risk subjects with either type 2 diabetes, two or more metabolic risk factors, or steatosis on imaging. The 2021 AGA guidelines recommend calculating a fibrosis-4 index (FIB-4) score, and patients with scores above low-risk require further workup with FibroScan to assess liver stiffness measurement (LSM), a surrogate for liver fibrosis. However, FIB-4 scores have been suggested to be less accurate in patients with type 2 diabetes. The aim of our study was to identify the prevalence of significant to advanced fibrosis in subjects with a low-risk FIB-4 value with FibroScans LSM in type 2 diabetes. Methods: A total of 1,153 subjects were referred to our liver center between August 2019 and September 2022; 1,114 subjects met MASLD criteria with data to calculate FIB-4 values. Subjects were categorized into age adjusted low-risk FIB-4 groups. Diagnosis of diabetes was determined by medical history. Results: Low-risk age-adjusted FIB-4 scores were observed in 68.3% of older subjects and 73.4% of younger subjects (P = not significant (NS)). In the older group and younger cohorts, a LSM 10 kPa was noted in 21% suggesting advanced liver fibrosis. Seventy-one point six percent of older diabetic subjects had low FIB-4 values, similar to 67.2% of young diabetic subjects with low FIB4 values. Overall, 72% of subjects would not have been referred for FibroScan per AGA criteria. Despite low-risk FIB-4 scores, 257 subjects had LSM greater than or equal to 8 kPa and 148 underwent a liver biopsy. Forty-eight percent of patients with biopsies had significant fibrosis (F2-4), predominately affecting subjects with type 2 diabetes. Conclusions: Diabetic subjects, despite having a low-risk FIB-4 tests, were four-fold more likely to demonstrate significant to advanced fibrosis, highlighting the limitations of FIB-4 in these individuals. J Endocrinol Metab. 2024;14(1):40-47 doi: https://doi.org/10.14740/jem935
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".