What question did this study set out to answer?

Evaluate the effectiveness of the FIB-4 index for detecting liver fibrosis in patients with type 2 diabetes.

June 24, 2026Open Access

A Cross-Sectional Observational Study of Non-alcoholic Fatty Liver Disease Assessed by Fibrosis Index in Patients With Type 2 Diabetes Mellitus Presenting to a Tertiary Care Centre in Southwestern Maharashtra

Key Points

Evaluate the effectiveness of the FIB-4 index for detecting liver fibrosis in patients with type 2 diabetes.
Cross-sectional observational study conducted in a tertiary care center with 150 patients diagnosed with type 2 diabetes.
Assessment of liver fibrosis using the FIB-4 score and ultrasound elastography to measure liver stiffness.
Correlation and receiver operating characteristic (ROC) curve analysis for statistical evaluation.
73.3% of patients were diagnosed with non-alcoholic fatty liver disease (NAFLD) via ultrasound.
Majority of patients had fibrosis stage F2 (52.0%) with an average liver stiffness of 8.97 ± 2.50 kPa.
The FIB-4 index showed excellent diagnostic performance for significant fibrosis with an area under the ROC curve of 0.951 (95% CI: 0.918-0.983).

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is associated with progressive fibrosis and adverse clinical outcomes. Early identification of fibrosis using non-invasive methods is essential. This study aimed to evaluate the diagnostic utility of the Fibrosis-4 (FIB-4) index and compare it with ultrasound elastography in detecting liver fibrosis. Methods: A cross-sectional observational study was conducted in a tertiary care center and included 150 patients with T2DM. Demographic, clinical, and laboratory parameters were recorded. The FIB-4 score was calculated using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count. Liver stiffness was assessed using ultrasound elastography, and fibrosis was staged from F0 to F4. Statistical analysis included correlation and receiver operating characteristic (ROC) curve analysis. Results: Out of 150 patients, 110 (73.3%) were found to have NAFLD on ultrasound. Fibrosis staging revealed that the majority of patients were in stage F2 (52.0%), followed by F3 (27.3%), F0 (13.3%), F1 (4.7%), and F4 (2.7%). The mean liver stiffness was 8.97 ± 2.50 kPa. A strong positive correlation was observed between FIB-4 score and liver stiffness (ρ = 0.804, p < 0.001). AST showed a strong positive correlation with liver stiffness (r = 0.744, p < 0.001), whereas platelet count demonstrated a moderate negative correlation (r = -0.472, p < 0.001). The diagnostic performance of FIB-4 for detecting significant fibrosis was excellent, with an area under the ROC curve of 0.951 (95% CI: 0.918-0.983). Conclusions: NAFLD and significant liver fibrosis are highly prevalent in patients with T2DM. The FIB-4 index demonstrates strong correlation with elastography and excellent diagnostic accuracy, making it a reliable, cost-effective, non-invasive screening tool for liver fibrosis.

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