Screening for Hepatic Fibrosis Using an Automatically Calculated FIB-4 Score in Patients with Type 2 Diabetes: A Single-Center Study.

Background

Patients with type 2 diabetes (T2D) are at high risk of metabolic dysfunction-associated steatotic liver disease, which may progress to advanced fibrosis but remains underdiagnosed in routine clinical practice. Automated laboratory-based tools may improve early identification of at-risk patients.

Methods

We conducted a retrospective single-center study between January 2023 and August 2025 including 445 patients with T2D. The Fibrosis-4 (FIB-4) score was automatically calculated through the laboratory information system. Its diagnostic performance was assessed in patients who underwent transient elastography (TE).

Results

The median age was 58 years, 64% of patients were obese, and 55% were men. Men had a higher risk of elevated FIB-4 (odds ratio = 1.32, P < 0.05). FIB-4 was ≥1.3 in 36.9% of patients. Among the 43 patients referred for TE, 26 (60.5%) had significant fibrosis. FIB-4 correlated with liver stiffness (r = 0.48; P < 0.01), with an area under the ROC curve of 0.74 (95% CI, 0.58-0.89) for detecting significant fibrosis (≥8 kPa) using a cutoff of 1.33 (sensitivity 84.6%; specificity 47.1%). Patients with significant fibrosis had significantly higher alkaline phosphatase (P = 0.03) and C-reactive protein levels (P = 0.01). Only 14% of at-risk patients underwent TE.

Conclusions

Automated calculation of FIB-4 enables identification of patients with T2D at risk of liver fibrosis in routine practice. However, its clinical impact may be limited by low referral rates for confirmatory testing. The diagnostic performance estimates reported here derive from a selected TE subcohort and should therefore be interpreted with caution. Integration of such laboratory-based tools into clinical workflows may support earlier detection, provided that appropriate care pathways are implemented.