Combining Retinal Scanning and Liver Screening in T2D

TOPLINE:

Simultaneous screening for liver fibrosis during retinal scanning shows promise as a novel pathway for detecting advanced liver disease in patients with type 2 diabetes (T2D).

METHODOLOGY:

• International guidelines recommend screening for liver disease in people at risk for metabolic dysfunction–associated steatotic liver disease (MASLD), particularly those with T2D, among whom hepatic steatosis is common.
• Researchers behind this cross-sectional study offered vibration-controlled transient elastography (VCTE) to patients with T2D during their routine care at a major retina scanning facility in Stockholm.
• They excluded those with type 1 diabetes, pregnancy, known liver disease, or high alcohol consumption; non-Swedish speakers; or individuals aged
• Analysis included liver stiffness measurements, with values ≥ 8.0 kPa indicating increased liver stiffness and > 12.0 kPa possible advanced fibrosis, and controlled attenuation parameter (CAP) values ≥ 280 dB/m indicating MASLD.
• The primary outcome was the proportion of eligible participants who accepted screening, and the secondary outcomes included the prevalence of elevated liver stiffness and MASLD.

TAKEAWAY:

• Among 1301 eligible candidates, 1005 (77.2%) agreed to undergo a liver examination simultaneously with retinal screening.
• Complete measurements were obtained in 973 participants, with 504 having CAP values ≥ 280 dB/m, indicating MASLD.
• Among 977 patients with reliable liver stiffness measurements, 154 had values ≥ 8.0 kPa, and 49 had values > 12.0 kPa, suggesting liver fibrosis and advanced disease, respectively.
• However, after reassessment with a second VCTE, conducted a median of 39 days after the first screening, the number of participants with liver stiffness values ≥ 8.0 kPa or > 12 kPa dropped to 74 and 29, respectively.

IN PRACTICE:

Noting that false positives were potentially common on second visits, the authors wrote, “This risk must be considered if implementing this method into clinical routine.”

“It is possible that only doing a VCTE in patients with an elevated [fibrosis-4] score, by increasing pretest probability of fibrosis, might lead to a higher positive predictive value than a single VCTE without confirmation,” experts from the School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy, wrote in an accompanying editorial.

SOURCE:

The study was led by Andrea Lindfors, MD, Division of Hepatology, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden. It was published online in The Lancet Gastroenterology & Hepatology.

LIMITATIONS:

There were large amounts of missing laboratory data from initial visits, primarily due to the absence of an on-site blood test facility. The COVID-19 pandemic may have influenced participants’ willingness to engage with healthcare services. The use of different VCTE devices at different sites could have affected measurement values. Researchers did not verify the presence of advanced fibrosis through liver biopsy in participants with liver stiffness measurements exceeding 12.0 kPa at the second visit.

DISCLOSURES:

The study received funding from Gilead Sciences, Pfizer, Region Stockholm, and other sources. One author declared receiving research funding, serving as a consultant or on advisory boards, and having other ties with several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.