O-5 PROGNOSTIC IMPORTANCE OF TRANSIENT ELASTOGRAPHY (FIBROSCAN®) FOR MORTALITY AND CARDIOVASCULAR OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES

Background and Aims

It remains unknown whether advanced liver fibrosis is associated with a higher risk of cardiovascular complications in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD).The aim was to evaluate the prognostic value of transient elastography (TE) by Fibroscan® as a predictor of mortality and cardiovascular outcomes in T2DM.

Methods

On a prospective study, T2DM patients with no other cause of liver disease except NAFLD underwent TE at baseline and were followed-up for the evaluation of outcomes, including all-cause mortality and occurrence of any cardiovascular event. The associations between TE scores and outcomes were evaluated by Cox regressions adjusted for other potential confounders. Liver stiffness measurement (LSM) and Controlled attenuation parameter (CAP) were evaluated as continuous variables and categorized as advanced fibrosis if LSM >7.9 or 7.2 kPa (M-XL probe) and severe steatosis if CAP>296 dB/m.

Results

403 T2DM patients were included (64% female, mean age of 64±10 yrs) and followed for 94 months until March 2020. 395(98%) of the TE examinations were successful. At baseline, 104(26%) individuals had advanced fibrosis and 150(38%) had severe steatosis. During follow-up, 55(14%) patients died, 55(14%) had cardiovascular events, including 35 with coronary artery disease (CAD). As continuous variables, LSM (↑1 kPa) predicted all-cause mortality (HR 1.05, 95%CI 1.01-1.08,p=0.020) and CAP (↑20 dB/m) was associated with a significant reduced risk of cardiovascular mortality (HR 0.80,95%CI 0.66-0.96,p=0.014) and CAD (HR 0.81,95%CI 0.70-0.95,p=0.007). Increased LSM was associated with a significant 98% excess mortality risk (p=0.025), whereas a higher CAP was associated with a borderline 49% reduced risk (p=0.08).

Conclusion

Advanced fibrosis is associated with all-cause mortality, independent of other potential risk factors. Severe steatosis could have some effect in the reduction of cardiovascular mortality and CAD events. Transient elastography may be useful to improve stratification risk of T2DM patients.