Interest of hepatic steatosis index (HSI) in screening for metabolic steatopathy in patients with type 2 diabetes

Abstract

Introduction: metabolic steatopathy or non-alcoholic fatty liver disease (NAFLD) is frequently associated with type 2 diabetes mellitus (T2DM) with an increased risk of progression to advanced fibrosis. The purpose of our study was to determine the interest of hepatic steatosis index (HSI) in the detection of hepatic steatosis in patients with type 2 diabetes in order to establish an appropriate screening program of this disease in our population. Methods: cross-sectional study involving 281 type 2 diabetics hospitalized in the Department of Endocrinology in collaboration with the hepato-gastroenterology department at the University Hospital Ibn Rochd Casablanca between January 2018 and June 2018. Anthropometric variables studied were, biological, hepatic steatosis index (HSI) and liver ultrasound. The HSI score of> 36 predicted the presence of fatty liver. The HSI score (fatty liver index) was calculated for all patients using the following formula: 8 × (ALT / AST) + BMI + 2 (if type 2 diabetes) + 2 (if female). Statistical analysis was performed with SPSS Version 19 software. The sensitivity and the specificity of the HSI score were calculated by 2x2 contingency table. The area under the receiver operating characteristic curve (AUROC) was also analyzed. Results: average age of patients was 54.15 ± 13.14 years with a female predominance (76.9% of cases), and a sex ratio of 3.32. Mean duration of diabetes of 10.5 ± 8.03 years with an average glycated hemoglobin of 10.23 ± 1.96%. BMI was 29.53 ± 4.55 kg/m², the average waist circumference was 99.51 ± 10.98 cm. 39.1% of patients were hypertensive, 58% were dyslipidemic. Abnormalities in transaminases were found in 6% of patients. Prevalence of NAFLD was 45.2% based on the HSI score > 36. This prevalence is consistent with the findings made by the liver ultrasound (47.7% of cases). Hepatic steatosis was significantly correlated with dyslipidemia (P=0.006), overweight (P=0.00015), obesity (P=0.001) and hypertriglyceridemia (P=0.0003). The sensitivity of HSI was 89.55%, negative predictive value (NPV) was 90.91%, specificity was 95.24%, and positive predictive value (PPV) was 94.49%. AUROC for HSI was at 0.979 (95% CI, 0.962-0.997). Conclusion: hepatic steatosis is common among our patients; it is correlated with dyslipidemia, obesity and hypertriglyceridemia.