LIVER FIBROSIS ASSESSMENT IN DIABETESMELLITUS PATIENTSUSINGELASTOGRAPHY IN A TERTIARY CARE HOSPITAL

Introduction:Diabetesmellitusisoneofthemostcommondiseasewithanestimateofaround Diabetes 400millionpopulationaffectedworldwide.Diabetesisadiseaseofcomplications,bothacute and chronic. There is a wide range of liver manifestations associated with Diabetes. Many diabetic patientshave beendetectedwithfattyinfiltrationof liver,mainlymanifestedasNon- alcoholic fatty liver disease (NAFLD).In India ,NAFLD is emerging as an important cause of liverdisease.NAFLDpatientswithDiabeteshasincreasedchanceofdevelopingcomplications of chronic liver disease including liver fibrosis.Toassess hepatic fibrosis, liver biopsy is still theonlyreliablegoldstandard.However,thismethodisinvasiveandassociatedwithpossible risks and complications, hence non-invasive imaging methods like serum biomarkers, conventional ultrasound, ultrasound elastography are beingused for assessment of liver stiffness measurement(LSM). Aims and Objectives: To studythepattern of significant liver fibrosis in diabetes mellitus patients with non alcoholic fatty liver disease usingtransient elastography. To determine the association of liver stiffness by elastography with other factors in diabetes mellitus patients.Tostudythecorrelationbetweennon-invasivescoresofNAFLDandliverstiffnessmeasure in patients with non alcoholic fatty liver disease usingtransient elastography. Method:Cross sectional study was done in 108 patients with Diabetes& Fatty liver visiting SreeGokulam medical college between May 2021 & May 2022. Correlation was studied betweenliver stiffness byelastographywith other riskfactors. Cohenskappacoefficient was used to find agreement between FIB4 Score, APRIScore,BARD Score and fibroscanresults . Result: 42%ofmale patients(18)and38%offemalepatientshadF3&F4liverstiffnesswhile 19 patients had F1 & F2 liver stiffness. The mean age of the study population is 50.12 years. 79% of males and 61 % of females were found to be obese. Out of obese patients,45 % had significant liver stiffness. 95% of patients with F3/F4 stage of liver stiffness had elevated HbA1c(n=41)whichshowedasignificantcorrelation(p<0.02).ASTelevati onhadasignificant correlation with significant fibrosis (p<0.05) .55% of elevated AST cases had F3/F4 liverstiffness.CohenskappacoefficientshowedsubstantialagreementbetweenresultsofFibroscan and APRI,BARD&FIB-4.Conclusion:Significantfibrosiswasdetectedmainlyinobesewithpoorglycaemic control&dyslipidaemia. Elevated liver enzymesalso had a significant correlation with significant fibrosis. Timely diagnosis of NAFLD and intervention is essential to reduce the risk of liver disease progressionespecially in diabetic patients.