Correlation of Routine Biological Parameters in Predicting Hepatic Steatosis and Fibrosis in Type 2 Diabetic Patients

Aims Metabolic-associated fatty liver disease (MASLD) is the most common liver disease in patients with type 2 diabetes (T2D). There is a reciprocal relationship between these two conditions, with each exacerbating the other. Current guidelines recommend routine screening for MASLD in T2D patients. The aim of this study is to examine the correlation between simple biological parameters and their predictive value in diagnosing hepatic steatosis and fibrosis in this population.

Methods This is a prospective cross-sectional study involving 122 patients with T2D over a 10-month period. Hepatic steatosis was confirmed by abdominal ultrasound, and hepatic fibrosis was measured by FibroScan. Significant fibrosis was defined as a liver stiffness measurement (LSM)≥8 kPa.

Results Transaminases and gamma-glutamyl transferase (GGT) levels were significantly higher in patients with MASLD. Cytolysis was observed exclusively in the MASLD group, with 7 patients showing this finding, which was statistically significant (p=0.017). Additionally, GGT levels above the upper normal limit were significantly associated with the presence of hepatic steatosis (24.59% vs 7.69%, p=0.002). Using a ROC curve, we defined a predictive threshold for GGT in hepatic steatosis diagnosis, with a cutoff value of 50.3 IU/L, showing a sensitivity of 67%, specificity of 65%, and an area under the ROC curve (AUROC) of 0.68 (Figure 6). Moreover, alkaline phosphatase (ALP), bilirubin, and albumin levels did not influence the incidence of steatosis. There were no significant differences between the two groups regarding biological abnormalities, except for the presence of elevated GGT. A significant difference was observed (p<0.001), with an average GGT level of 71.42 IU/L in the group with significant fibrosis. The mean alanine aminotransferase (ALT) level was higher in the fibrosis group compared to the non-fibrosis group, with a statistically significant difference (p=0.002). However, the presence of cytolysis, defined by values above normal, was not predictive of fibrosis. It is concluded that the threshold for ALT indicating suspected fibrosis should be lowered within the normal range. The ROC curve allowed the establishment of cutoff values for GGT and ALT to predict the presence of significant fibrosis, with cutoff values of 48.5 IU/L and 18.5 IU/L, respectively.

Conclusions Diabetic patients with hepatic enzyme levels exceeding these thresholds are at higher risk for MASLD. These findings suggest that ALT levels could be combined with other non-invasive methods to detect significant fibrosis.

Publication History

Article published online:
27 March 2025