P1161 - The Role of Fibroscan in Assessment of Liver Fibrosis in Patients With Diabetes Mellitus and Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD)

Raakhi Menon, DO, Giri Movva, MD, Devin Garza, BS, Edward Butt, MD, Julia Zhang, MD, Kashif Khan, MD
University of Texas Medical Branch, Galveston, TX

Introduction: The accurate assessment of fibrosis and cirrhosis risk is crucial in chronic liver disease management. While liver biopsy was the gold standard, noninvasive tests like the FIB-4 index (using age, AST, ALT, platelet count) and transient elastography (Fibroscan) are now preferred. The AASLD and AGA currently recommend starting with a primary risk assessment using a serologic test like FIB-4 and then proceeding to a secondary risk assessment only if FIB-4 ≥ 1.3 (≥ 2 if over the age of 65).

However, in patients with diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), FIB-4 may underestimate the degree of fibrosis. Direct referral to Fibroscan could provide a more accurate assessment in this population.

Methods: We conducted a retrospective analysis to evaluate the effectiveness of noninvasive liver fibrosis scoring systems in patients with and without diabetes. Using a query system within our institution’s electronic medical record, we identified all patients who received a Fibroscan study from 2020 to 2024. Inclusion criteria consisted of patients over the age of 35 who met the criteria for MASLD, while those with other potential contributors to liver disease were excluded.

Results: From a cohort of 806 patients who underwent a Fibroscan, we included 293 individuals in our final analysis based on the criteria above. There were 191 females and 102 males, with 96 identifying as Hispanic. Of the 293, 114 had diabetes while 179 did not. When comparing patients with and without diabetes, the presence of an elevated FIB-4 score was not significantly different between the two groups (57.9% vs. 46.9%, p-value 0.0730). However, when comparing the presence of an elevated liver stiffness measurement (LSM) score on Fibroscan (7.5 kPa and above), there was a statistically significant difference between the diabetic and nondiabetic groups (54.4% vs. 26.8%, p-value 0.0001). Notably, of the 48 diabetic patients with a low FIB-4 score, 17 patients or 35.4% had an elevated LSM score on Fibroscan.

Discussion: The FIB-4 index may underestimate liver fibrosis in diabetic patients. Developing a targeted approach to liver fibrosis assessment in those with diabetes and MASLD is crucial. This enables us to accurately identify high-risk patients and ensure they receive the necessary testing and treatment. We recommend direct Fibroscan referral for diabetic patients, irrespective of their FIB-4 score.


Disclosures:


Raakhi Menon, DO, Giri Movva, MD, Devin Garza, BS, Edward Butt, MD, Julia Zhang, MD, Kashif Khan, MD. P1161 - The Role of Fibroscan in Assessment of Liver Fibrosis in Patients With Diabetes Mellitus and Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.