The fibrosis-4 index for advanced liver fibrosis in NAFLD with T2DM: Half a loaf is better than no bread

Article information

Clin Mol Hepatol. 2025;31(1):e25-e26

Publication date (electronic) : 2024 December 10

doi : https://doi.org/10.3350/cmh.2024.0993

Zeyu Wang^1,*, Dong Wan^1,*, Meidong Xu¹, Yong Jiang^,2

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China

²Department of Gastroenterology, the Second Hospital of Tianjin Medical University, Tianjin, China

Corresponding author : Yong Jiang Department of Gastroenterology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China Tel: +86-022-88328825, Fax: +86-022-88328825, E-mail: jiangyong-612@163.com

*These authors have the same contribution.

Editor: Gi-Ae Kim, Kyung Hee University, Korea

Received 2024 November 5; Revised 2024 November 20; Accepted 2024 December 8.

Dear Editor,

We recently observed a meta-analysis conducted by Han et al. [1] published in your esteemed journal, which we examined with considerable interest. Upon review, we have identified several issues that we believe merit further attention, as they may provide valuable insights into the Diagnostic accuracy of the Fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes mellitus (T2DM).

We would like to express our gratitude for the publication by Han et al. [1], which significantly contributes to the field. This article predominantly investigates the importance of the fibrosis-4 (FIB-4) index as a non-invasive diagnostic tool for NAFLD in individuals with T2DM. The numerous studies on the topic identified a strong correlation between T2DM and NAFLD. A meta-analysis has demonstrated that the global prevalence of NAFLD among patients with T2DM researched 55.5% (95% CI 47.3–63.7) [2]. Within this meta-analysis, a notable proportion exhibit advanced advanced liver fibrosis (17.0%, 95% CI 7.2–34.8). Consequently, the early detection of liver fibrosis progression in NAFLD patients with concurrent T2DM is of critical importance. This study represents the first investigation into the clinical relevance of the non-invasive diagnostic marker FIB-4, specifically examining its utility in the non-invasive diagnosis of liver fibrosis in NAFLD patients with T2DM.

However, the article has the following issues to be addressed. Firstly, the research did not distinguish between cross-sectional and cohort studies, choosing instead to include them for analysis. This methodological decision may impact the final outcomes. Secondly, an increasing number of literature suggests that FIB-4 has predictive value regarding renal function [3]. However, in this article, it is noteworthy that a substantial proportion of the patients [4] included in the studies exhibit renal insufficiency, potentially affect the predictive accuracy of FIB-4. Last but not least, according to the references cited in the text, three studies from the same researcher [5-7] may be an overlap in patient populations across these researches, and the number of patients included is large, which could further contribute to bias in the findings.

In conclusion, this article elucidates the diagnostic utility of the FIB-4 index in assessing liver fibrosis among patients with NAFLD and T2DM, thereby presenting a potential advancement in non-invasive diagnostic methods. Nevertheless, the limited specificity and sensitivity of the FIB-4 index constrain its clinical applicability. The implementation of non-invasive diagnostic markers for the screening of liver fibrosis in patients with NAFLD and T2DM represents a promising and advantageous endeavor.