Journal of diabetes research · 2026
Association of FIB-4, APRI, and HellenicSCORE II With Chronic Kidney Disease in Patients With Type 2 Diabetes Mellitus.
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Stefanaki Katerina, Karagiannakis Dimitrios S, Manolakopoulou Maria, Magkou Stefania, Kazakou Paraskevi, Zacharaki Panagiota, Peppa Melpomeni, Kassi Evanthia, Psaltopoulou Theodora, Paschou Stavroula A
Аннотация
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) commonly affects patients with Type 2 diabetes mellitus (T2DM). Fibrosis-4 (FIB-4) has been linked to chronic kidney disease (CKD) in patients with MASLD; however, its association with CKD in broader, not preselected for MASLD, T2DM populations remains unclear.
AIM: To investigate the association of FIB-4 with CKD in unselected patients with T2DM and compare its discriminatory ability with that of HellenicSCORE II and aspartate aminotransferase-to-platelet ratio index (APRI).
METHODS: We retrospectively analyzed data from consecutive patients with T2DM. Characteristics and baseline laboratory results were recorded.
RESULTS: A total of 214 patients (mean age 67.6 ± 10.3 years) were enrolled, including 158 (73.8%) males and 56 (26.2%) females. Ninety-six (44.8%) had normal kidney function, and 54 (25.2%) had CKD at enrollment. Those with CKD were significantly older (p = 0.002) and had higher scores on the HellenicSCORE II (p = 0.004), APRI (p = 0.001), and FIB-4 (p < 0.001). Additionally, hypertension and cardiovascular disease were more common in the CKD than in the non-CKD group (p < 0.001 for both). In the multivariate analysis, sex (OR: 0.13, 95% CI: 0.03-0.6; p = 0.008) and FIB-4 (OR: 10.4, 95% CI: 2-54.1; p = 0.005) were independently associated with CKD. Among the evaluated scores, FIB-4 demonstrated the highest numerical AUROC for identifying CKD (0.769; 95% CI: 0.668-0.869), compared with APRI (0.668; 95% CI: 0.558-0.778) and HellenicSCORE II (0.651; 95% CI: 0.544-0.757).
CONCLUSIONS: FIB-4 was independently associated with the presence of CKD in patients with T2DM and demonstrated the highest numerical AUROC among the evaluated scores.
AIM: To investigate the association of FIB-4 with CKD in unselected patients with T2DM and compare its discriminatory ability with that of HellenicSCORE II and aspartate aminotransferase-to-platelet ratio index (APRI).
METHODS: We retrospectively analyzed data from consecutive patients with T2DM. Characteristics and baseline laboratory results were recorded.
RESULTS: A total of 214 patients (mean age 67.6 ± 10.3 years) were enrolled, including 158 (73.8%) males and 56 (26.2%) females. Ninety-six (44.8%) had normal kidney function, and 54 (25.2%) had CKD at enrollment. Those with CKD were significantly older (p = 0.002) and had higher scores on the HellenicSCORE II (p = 0.004), APRI (p = 0.001), and FIB-4 (p < 0.001). Additionally, hypertension and cardiovascular disease were more common in the CKD than in the non-CKD group (p < 0.001 for both). In the multivariate analysis, sex (OR: 0.13, 95% CI: 0.03-0.6; p = 0.008) and FIB-4 (OR: 10.4, 95% CI: 2-54.1; p = 0.005) were independently associated with CKD. Among the evaluated scores, FIB-4 demonstrated the highest numerical AUROC for identifying CKD (0.769; 95% CI: 0.668-0.869), compared with APRI (0.668; 95% CI: 0.558-0.778) and HellenicSCORE II (0.651; 95% CI: 0.544-0.757).
CONCLUSIONS: FIB-4 was independently associated with the presence of CKD in patients with T2DM and demonstrated the highest numerical AUROC among the evaluated scores.