Interest of the CAP (Controlled Attenuation Parameter) in the Diagnosis of Hepatic Steatosis and Prediction of Significant Fibrosis in Type 2 Diabetic Patients

Aims The CAP is a measure that quantifies hepatic steatosis, complementing liver stiffness evaluation (Liver Stiffness Measure, LSM) obtained by transient elastography. This method is not yet recommended by medical societies for screening hepatic steatosis or predicting fibrosis in Type 2 diabetes (T2D) patients. The aim of this study is to analyze the role of this parameter in diagnosing both steatosis and fibrosis.

Methods This is a cross-sectional prospective study including 122 T2D patients over a period of 10 months. Hepatic steatosis was confirmed by abdominal ultrasound, and all patients underwent transient elastography. The CAP was measured using an M or XL probe, expressed in decibels per meter (dB/m). Hepatic steatosis was defined by a CAP≥275 dB/m, while significant fibrosis was defined by a LSM value≥8 kPa.

Results The average age of patients was 60.04±9.82 years, with a predominance of women (73.77%). The mean CAP value was 267.99 dB/m, ranging from 100 dB/m to 391 dB/m. The prevalence of hepatic steatosis according to the CAP was 55.73% (n=68). Abdominal ultrasound and CAP were concordant in 66.35% of cases (71 patients). The Kappa test for concordance showed a weak agreement between the CAP parameter and abdominal ultrasound (Kappa=0.27). Regarding hepatic fibrosis, 21 patients (17.21%) had a LSM≥8 kPa. CAP analysis relative to LSM revealed that the mean CAP was significantly higher in patients with significant fibrosis (300.90 dB/m vs. 261.14 dB/m), with a statistically significant difference (p=0.035). Additionally, a CAP≥275 dB/m, defining the presence of hepatic steatosis, was associated with significant fibrosis (p=0.002).

Conclusions Although the concordance of results for diagnosing hepatic steatosis with the CAP parameter was low, it showed significance in predicting hepatic fibrosis. These results suggest that the CAP could be a useful tool for evaluating fibrosis in diabetic patients, highlighting the importance of an integrated approach in liver disease assessment.

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Artikel online veröffentlicht:
27. März 2025