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Aims: To determine whether the addition of complementary biomarker(s) to current NAFLD risk-stratification tools in people with Type 2 diabetes could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC.
Methods: The Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with Type 2 diabetes (n=1066, age 60-75 at baseline). Cases of cirrhosis and HCC were identified over 11-years of follow-up. Biomarkers were measured at baseline and year one and association with incident disease assessed using logistic regression.
Results: Of existing risk-stratification scores tested, the Fibrosis-4 (FIB-4) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut-point ≥50g/L) to FIB-4 (cut-point ≥1.3) maintained a false negative rate ≤25% and reduced the number of people incorrectly identified as ‘high-risk’ for incident disease by ~50%.
Conclusions: The addition of hyaluronic acid to FIB-4 reduced the proportion of people inappropriately identified as ‘high-risk’ for development of cirrhosis/HCC in a community population of otherwise asymptomatic people with Type 2 diabetes. These findings require validation in independent cohorts.
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