Editor's Note: On June 5, 2024, the European Association for the Study of the Liver (EASL) Annual Meeting commenced in Milan, Italy, bringing together experts and scholars from the global hepatology field. The conference aimed to share the latest developments and trends in liver disease research, providing valuable references for future research and clinical practice. On the first day of the conference, Academician Gaojun Teng of the Chinese Academy of Sciences and the initiator of the China Diabetes and Liver Disease Management (CDLM) initiative, along with Xiaolong Qi, founder of CHESS and co-initiator of CDLM, presented a novel study. They introduced the DiabetesLiver Score, a non-invasive tool to assess advanced liver fibrosis in type 2 diabetes (T2DM) patients and predict liver-related adverse events.

Research Background

Currently, over 500 million people worldwide suffer from diabetes, with type 2 diabetes (T2DM) being the most prevalent. T2DM not only causes systemic metabolic disorders and increases cardiovascular disease risk but also accelerates liver disease progression, significantly raising the risk of liver cirrhosis decompensation and liver cancer. Advanced liver fibrosis is a critical stage in chronic liver disease progression and an essential predictor of adverse liver outcomes. However, there is no effective non-invasive score to diagnose advanced liver fibrosis and predict liver-related adverse events in T2DM patients.

Research Methods

This multi-cohort study first developed and internally validated a non-invasive score to diagnose advanced liver fibrosis based on a nationwide multicenter cross-sectional cohort of T2DM patients. Then, the diagnostic performance was externally validated using the NHANES 2017-2020 cross-sectional cohort and a tertiary hospital liver biopsy cohort. Finally, the UK Biobank long-term follow-up cohort was used to assess the new score’s ability to predict liver cancer and liver-related mortality risk.

Research Results

The study included a total of 28,197 T2DM patients. In the development cohort (n=1,129), waist circumference, ALT, AST, platelets, and albumin were identified as independent risk factors for advanced liver fibrosis (liver stiffness ≥12 kPa). These factors were used to develop a new non-invasive score, named the “DiabetesLiver Score.”

Analysis showed that the DiabetesLiver Score had an area under the curve (AUC) of 0.835 (95% CI: 0.781-0.890) for diagnosing advanced liver fibrosis, significantly better than existing non-invasive scores (FIB-4, NFS, and BARD, all P < 0.01). In the internal validation cohort (n=1,000), NHANES cross-sectional cohort (n=1,432), and liver biopsy cohort (n=191), the DiabetesLiver Score’s AUCs were 0.870 (95% CI: 0.813-0.927), 0.823 (95% CI: 0.886-0.959), and 0.769 (95% CI: 0.663-0.876), respectively, outperforming existing scores. The sensitivity and specificity of the DiabetesLiver Score for diagnosing advanced liver fibrosis were both 90%.

Using cut-off values of 2.39 and 3.99, T2DM patients were classified into low, medium, and high-risk groups. In the UK Biobank follow-up cohort (n=24,636), patients in the high-risk group (DiabetesLiver Score >3.99) had significantly higher risks of liver cancer (HR 35.344, 95% CI: 4.926-253.589) and liver-related mortality (HR 6.091, 95% CI: 3.214-11.543) compared to those in the low-risk group (DiabetesLiver Score <2.39), both P < 0.001.

Research Conclusion

In T2DM patients, the novel non-invasive DiabetesLiver Score, based on common serum markers, effectively assesses advanced liver fibrosis and significantly outperforms existing non-invasive methods. Additionally, this score can accurately predict the risks of liver cancer and liver-related mortality in the T2DM population.

Expert Profiles

Gaojun Teng

• Academician, Chinese Academy of Sciences
• Director, Medical and Life Sciences Department, Southeast University
• President and Director, Interventional Therapy Center, Zhongda Hospital, Southeast University
• Recipient of three National Science and Technology Progress Awards (Second Prize)
• Founding Editor-in-Chief, EngMedicine
• Founding President, International Society of Multi-disciplinary Interventional Oncology (ISMIO)
• President, Chinese Interventional Doctor Association (CCI)
• Head, National Medical Research and Development Integration Innovation Platform
• Director, National Comprehensive Interventional Technology Quality Control Center

Xiaolong Qi

• Young Scholar, Changjiang Scholars Program, Ministry of Education
• Head, Chronic Liver Disease Alliance Expert Group, National Health Development Research Center
• Assistant to the President and Director, Portal Hypertension Center, Zhongda Hospital, Southeast University
• Founder and Chairman, CHESS
• Founder and Editor-in-Chief, PH&C Journal
• Recipient of the Rising Star Award, Asia-Pacific Association for the Study of the Liver (APASL)
• Chairman, Portal Hypertension Committee, China Human Health Science and Technology Promotion Association
• Recipient of the First Huaxia Young Medical Science and Technology Award

Chuan Liu, Ph.D.

• Postdoctoral Fellow, Zhongda Hospital, Southeast University
• Secretary-General, Portal Hypertension Alliance, National Center for Infectious Diseases Medicine
• Deputy Secretary-General, Portal Hypertension Professional Committee, China Human Health Science and Technology Promotion Association
• Focused on research related to the diagnosis and monitoring of cirrhotic portal hypertension for many years.
• First author (or co-first author) of nine papers published in prestigious SCI journals, including J Hepatol, J Med Virol (two papers), Am J Gastroenterol, Med, and Hepatol Int.
• Holder of one software copyright (first author).
• Recipient of the APASL STC Young Research Scholar Award in 2020.