Advanced liver fibrosis a red flag for poor outcomes in T2D

Among individuals with type 2 diabetes (T2D), the risk of poor outcomes such as heart failure and hospitalizations is high in the presence of advanced liver fibrosis, according to a study.

The study included 1,734 patients with T2D who underwent transient elastography to examine their liver status. Liver status was characterized by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Liver steatosis was defined by CAP ≥248 dB/m, whereas advanced liver fibrosis was defined by LSM ≥10 kPa.

The cohort had a mean age of 60.8 years, with 56 percent of participants being men. The mean glycated haemoglobin (HbA1c) was 7.8 percent. At baseline, 798 participants had liver steatosis, 296 had advanced liver fibrosis, and 640 had normal liver status.

Participants with T2D and advanced liver fibrosis tended to have higher body mass index, waist circumference, waist-hip ratio, fasting plasma glucose, HbA1c, blood pressure, and lipid profiles relative to those with T2D and NAFLD or normal liver status (all p<0.05).

Over a median follow-up of 6.07 years, a total of 4,403 incident hospitalizations, 32,119 days of hospital stay, and 171 deaths were documented. Multivariable Cox regression analysis showed that advanced liver fibrosis was associated with increased risks of heart failure (hazard ratio [HR], 3.07, 95 percent confidence interval [CI], 1.08–8.68; p=0.035) and hospitalizations (HR, 1.39, 95 percent CI, 1.14–-1.70; p=0.001) compared with normal liver status.

Meanwhile, liver steatosis was associated with reduced mortality (HR, 0.60, 95 percent CI, 0.41–0.87; p=0.007) compared with normal liver status.

The findings suggest that T2D with comorbid liver steatosis and with comorbid advanced liver fibrosis are distinct clinical entities with differences in outcomes.