Performance of Liver Stiffness Measurement from FibroScan was Affected by Glucose Metabolism in Patients with Nonalcoholic Fatty Liver Disease

Abstract Background: The performance of liver stiffness measurement (LSM) obtained using FibroScan can be affected by several factors and cut-off values were different for fibrosis caused by various etiologies. The aim of this study was to evaluate the diagnostic performance of LSM in nonalcoholic fatty liver disease (NAFLD) patients with abnormal glucose metabolism and investigate whether LSM value would be affected by metabolic indicators. Methods: The study involved 91 NAFLD patients with abnormal glucose metabolism who underwent liver biopsy. The receiver operator characteristic (ROC) curves were used to evaluate the diagnostic accuracy, with the biopsy results taken as the gold standard. Multivariate linear regression and subgroup analysis were used to determine the correlated indicators.Results: The areas under ROC curves (AUROCs) of LSM values in diagnosing fibrosis stage≥1, 2, 3 and 4 were 0.793 (95% confidence interval [CI]: 0.695-0.871), 0.764 (95% CI: 0.663-0.846), 0.837 (95% CI: 0.744-0.906) and 0.902 (95% CI: 0.822-0.955), with cut-off values of 6.3, 7.6, 8.3 and 13.8 kPa, respectively. Multivariate linear regression demonstrated that HbA1c (β=0.200, p=0.038) and AST (β=0.200, p=0.044) were independently associated with LSM value after adjustment for fibrosis stage from liver biopsy. Subgroup analysis revealed that LSM values were slightly higher in patients with HbA1c ≥7% than those HbA1c <7%, and in patients with BMI ≥30kg/m2 than those BMI <30kg/m2.Conclusions: FibroScan was valuable for the evaluation of liver fibrosis in NAFLD patients with abnormal glucose metabolism. It was recommended for evaluating severe fibrosis, especially for excluding advanced fibrosis. Glucose metabolism state may affect LSM value.