Endocrine Abstracts

Introduction: The prevalence of abnormal liver function tests (LFTs) in the general population has been estimated to be 8.1–9.8%. Abnormal LFTs are common in diabetes although there are still few studies describing the exact prevalence. AST-to-platelet-ratio-index (APRI) and Fibrosis-4-score (FIB4) are scoring systems which can be used to estimate the degree of liver fibrosis. An APRI score >1 has a sensitivity of 76% and a specificity of 72% for predicting cirrhosis while a score >0.7 has a sensitivity of 77% and a specificity of 72% for predicting significant fibrosis. A FIB4 score > 3.25 has a 97% specificity and a positive predictive value of 65% for advanced fibrosis. A score <1.45 has a negative predictive value of 90% for advanced fibrosis.

Aims/Background: The aim of this retrospective study was to evaluate the prevalence of abnormal LFTs in patients attending a tertiary referral centre with diabetes. We also aimed to calculate APRI and FIB4 scores in this population.

Method: Electronic records were used to review all patients with who had LFTs processed in 2016. APRI and FIB-4 scores were calculated for each patient where the required variables (age, AST, ALT, and platelet count) were available.

Results: 1777 patients were included in the study, of whom 1077 were male and 700 were female. 212 had type 1, and 1565 type 2 diabetes (T2DM). 600 (33.76%) patients had at least one abnormal LFT. ALT was the most commonly elevated enzyme, 410 (23.1%) having an abnormal result. APRI and FIB4 scores could not be calculated in 734 (41.3%) patients, mostly due to unavailable platelet counts. Of the remaining 1043 (58.69%), 30 (2.88%, 30=T2DM) had an APRI score >0.7 while 17 (1.63%, 17=T2DM) had a score ≥1. 265 (25.41%) had FIB4 ≥1.45 and <3.25, and 18 (1.73%) patients had a score ≥3.25.

Conclusion: The results of this study demonstrate a high prevalence of raised LFTs in the diabetic population. ALT was the most commonly raised liver enzyme. A small but significant cohort of patients had APRI and FIB4 scores suggestive of cirrhosis and liver fibrosis, although the accuracy of these estimates will need to be histologically validated in diabetes. APRI and FIB-4 scores are potentially useful as routine screening tools for liver disease in diabetes in conjunction with history and clinical examination, but require addition of platelet count to the panel of routinely measured blood tests.