291-OR: A Noninvasive Index for Significant Liver Fibrosis and Stratifying Risk of Cirrhosis in Patients with Type 2 Diabetes Mellitus in Primary Care

Introduction & Objective: To propose a non-invasive index for detecting patients with T2DM at risk of significant liver fibrosis and cirrhosis in primary care. Methods: Five cohorts consist of 38,160 adults with T2DM were enrolled to develop and validate a non-invasive index for evaluating significant liver fibrosis and cirrhosis (Figure A). Results: Risk factors including Aspartate transaminase and boDy mass inDex were fitted to develop a test, termed the ADD index (available at: https://chess.nuist.edu.cn/consult/gzconsult/add_index). Using transient elastography (TE) as the reference, the ADD index performed better than FIB-4 and NFS for significant fibrosis (Figure B). A cutoff of 0 of the ADD index was selected to stratify patients into low- and high-risk group that should receive TE. AUC of the ADD index followed by TE was significantly higher than that of FIB-4 and NFS followed by TE (Figure B). Notably, using the ADD index combined with TE resulted in 11% cost savings compared to use TE alone. Compared with patients in low-risk group, those in high-risk group had a 2.90-fold (95% CI:1.44-5.82, P < 0.01) risk for cirrhosis (Figure C). Conclusions: The non-invasive ADD index can be applied to screen significant fibrosis and cirrhosis in patients with T2DM in primary care, and promoting those in high-risk group to further consult a hepatologist in secondary care.