Liver Stiffness Measurement Predicts Mortality Risk in Type 2 Diabetes: JAMA
Liver stiffness measurement (LSM) is an effective noninvasive tool for detecting liver fibrosis and identifying increased risk of all-cause mortality in patients with type 2 diabetes. It was found to be an independent predictor of mortality, unlike the FIB-4 index, supporting its inclusion in routine diabetes care despite potential limitations in access. The study was published in JAMA Network Open by Fernando B. and colleagues.
In the cohort analysis, LSM—but not the Fibrosis-4 (FIB-4) index—remained significantly associated with all-cause mortality, indicating that the inclusion of LSM in clinical practice may help in the early detection of high-risk patients. This study supports the idea that the use of LSM for the assessment of liver fibrosis may offer better prognostic accuracy than conventional methods for patients with metabolic diseases.
However, the existing guidelines suggest the use of LSM only when the FIB-4 index is raised. But the limitations of FIB-4, especially in patients with type 2 diabetes mellitus, have raised concerns about the underdiagnosis of liver fibrosis. Therefore, the aim of the present study is to evaluate the prognostic value of LSM and the relationship between liver fibrosis and mortality risk in populations with and without diabetes.
In this study, a total of 4102 adult patients with complete vibration-controlled transient elastography and controlled attenuation parameter data were included. Baseline patient demographic and laboratory data were obtained from a nationally representative database from 2017 to 2018 and linked to mortality outcomes up to December 31, 2019. The mean age of the population studied was 47 years, and there were 50.7% females.
The mean body mass index of these patients was 29.5 kg/m², and diabetes was prevalent in 14.5% of these patients. Liver disease was defined as a CAP value of ≥274 dB/m for metabolic dysfunction-associated steatotic liver disease, and significant fibrosis was defined as a liver stiffness of ≥9.7 kPa. The mean duration of follow-up for these patients was 24 months. The primary end point of interest for these patients was all-cause mortality, and it was assessed using Cox regression.
Key findings:
• The study found that 59 out of 4102 participants (1.4%) died. The deceased were found to be older (62 years vs. 47 years) and had a higher prevalence of diabetes (35.7% vs. 14.2%) and belonged to specific demographic groups.
• The study found a very strong correlation between liver disease and mortality, especially for people with diabetes.
• The combination of diabetes and MASLD was found to have a significant mortality risk (AHR 2.77; 95% CI, 1.16-6.65; P=0.03).
• The mortality risk was even higher for people with diabetes and liver fibrosis (AHR 6.41; 95% CI, 1.03-39.85; P=0.047).
• The most interesting finding is that for people with diabetes, liver stiffness measurements were found to be independently associated with mortality (AHR 1.06; 95% CI, 1.04-1.09; P<0.001) even after adjusting for age, gender, BMI, and HbA1c.
• The FIB-4 index, on the other hand, did not have a significant association.
This study proves that liver stiffness measurement is an independent predictor of mortality in diabetes patients and is more accurate in predicting mortality compared to traditional methods such as the FIB-4 index. It is believed that by using liver stiffness measurement in diabetes care, it will be possible to identify diabetes patients at high risk of mortality and thus improve patient outcomes.
Reference:
Bril F, Huynh K, Bolla PR. Liver Stiffness Measurement and All-Cause Mortality in Individuals With Diabetes. JAMA Netw Open. 2026;9(3):e260762. doi:10.1001/jamanetworkopen.2026.0762
