Non-Invasive Assessment of Liver Steatosis and Fibrosis Using Transient Elastography in a Tertiary Care Hospital: A Cross-Sectional Study among Patients with Type 2 Diabetes Mellitus
Abstract
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent in people with type 2 diabetes mellitus (T2DM), and fibrosis stage is the strongest determinant of liver-related outcomes. Liver biopsy is diagnostic but invasive and unsuitable for routine risk stratification. Vibration-controlled transient elastography (VCTE) provides a rapid, point-of-care estimate of fibrosis (liver stiffness measurement, LSM) and steatosis (controlled attenuation parameter, CAP). Methods: A hospital-based cross-sectional study was conducted at RLJH Hospital over 3 months. Adults with T2DM underwent clinical evaluation, anthropometry, biochemical testing (including HbA1c and aminotransferases), and VCTE. Steatosis was graded using CAP thresholds, and fibrosis stage was classified using LSM cut-offs (F0–F1 <7.0 kPa; F2 7.0–9.5; F3 9.5–12.5; F4 >12.5). Associations between CAP/LSM and BMI, waist circumference, HbA1c, liver enzymes, and diabetes duration were analyzed using chi-square tests, independent t-tests, correlation analysis, and multivariable regression. Results: Among 99 participants (mean age 54.2 ± 9.1 years; 58.6% male), steatosis (CAP ≥237 dB/m) was present in 73.7%: Grade 1 19.2%, Grade 2 28.3%, Grade 3 26.3%. Mean CAP was 278 ± 46 dB/m and correlated with BMI (r=0.52, p<0.001), waist circumference (r=0.47, p<0.001), and HbA1c (r=0.29, p=0.004). Mean LSM was 7.9 ± 3.6 kPa; significant fibrosis (≥F2) was found in 41.4% and advanced fibrosis (≥F3) in 20.2%. Significant fibrosis was associated with longer diabetes duration (11.1 ± 5.4 vs 6.8 ± 4.6 years, p<0.001) and higher ALT/AST (p<0.001). In adjusted analysis, diabetes duration (OR 1.12 per year) and ALT (OR 1.28 per 10 U/L) independently predicted significant fibrosis. Conclusion: VCTE identified a high burden of steatosis and a clinically meaningful prevalence of significant fibrosis in hospitalized adults with T2DM, supporting routine non-invasive liver assessment for risk stratification and targeted referral pathways.