Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: The Edinburgh type 2 diabetes study

Joanne R. Morling*, Jonathan A. Fallowfield, Indra N. Guha, Lisa D. Nee, Stephen Glancy, Rachel M. Williamson, Christine M. Robertson, Mark W.J. Strachan, Jackie F. Price

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Citations (Scopus)


Background & Aims It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research. Methods In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured. Results Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%). Conclusions We found poor correlation between the five biomarkers of liver fibrosis studied. Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease but poor agreement on the presence of advanced disease. Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints, in a range of different low and high risk population groups.

Original languageEnglish
Pages (from-to)384-391
Number of pages8
JournalJournal of Hepatology
Issue number2
Publication statusPublished - Feb 2014
Externally publishedYes

Bibliographical note

Funding Information:
The ET2DS was funded by a grant from the UK Medical Research Council and the Liver Substudy was supported by a grant from Pfizer. J.R.M. was supported by a Diabetes UK Clinical Research Fellowship. J.A.F is supported by a Clinician Scientist Fellowship from the Academy of Medical Sciences/The Health Foundation.


  • Hepatic fibrosis
  • Non-alcoholic fatty liver disease
  • Non-invasive biomarker tests
  • Type 2 diabetes mellitus


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