Enfermedad hepática esteatósica asociada a disfunción metabólica como riesgo de desarrollar fibrosis hepática en pacientes con diabetes mellitus tipo 2 utilizando métodos no invasivos, en el Instituto Nacional de Diabetes, Endocrinología y Nutrición (INDEN), durante el período noviembre 2023-abril 2024

Abstract

[Español] La diabetes mellitus es un grupo de alteraciones metabólicas que se caracteriza por hiperglucemia crónica, debida a un defecto en la secreción de la insulina, a un defecto en la acción de esta, o a ambas. Además de la hiperglucemia, coexisten alteraciones en el metabolismo de las grasas y de las proteínas. La hiperglucemia sostenida en el tiempo se asocia con daño, disfunción y falla de varios órganos y sistemas, en el caso que abordaremos el, hígado. La enfermedad hepática grasa por disfunción metabólica (MAFLD) es una de las complicaciones más frecuentes en DM2(50-70%), superando la prevalencia de nefropatía, retinopatía, neuropatía diabética. Así como puede presentarse MAFLD que duplique la probabilidad de desarrollar DM2. La fibrosis hepática es el proceso de cicatrización que representa la respuesta del hígado a una lesión. mediante la deposición de colágeno y otros componentes de la matriz. Con el tiempo, este proceso puede resultar en cirrosis del hígado, en la que la organización arquitectónica de las unidades funcionales del hígado se altera tanto que el flujo sanguíneo a través del hígado y la función del hígado se interrumpen. Una vez que se ha desarrollado la cirrosis, pueden ocurrir las complicaciones graves de la enfermedad hepática, como hipertensión portal, insuficiencia hepática y cáncer de hígado. es de importancia prevenir la progresión a fibrosis hepática en pacientes que cursan con múltiples complicaciones, siendo la MASLD más frecuente de lo esperado. Dentro de los marcadores no invasivos se encuentra la prueba fib-4 estima el grado de fibrosis hepática y permite clasificar correctamente al 87% de los pacientes con fibrosis hepática avanzada y así evitar la biopsia con un 71% de exactitud. Se detectó un valor predictivo negativo de fibrosis del 90% y un valor predictivo positivo de 65% en los puntos de corte establecidos. Metodología: Se realiza un estudio observacional, descriptivo, correlacional, retrospectivo de corte transversal con el objetivo de determinar el grado de riesgo de desarrollar fibrosis hepática en pacientes con Diabetes Mellitus tipo 2 con enfermedad hepática esteatósica asociada a la disfunción metabólica mediante métodos no invasivos, en el Instituto Nacional de Diabetes, Endocrinología y Nutrición (INDEN) durante el periodo noviembre 2023-abril 2024.Resultados: A partir de los datos obtenidos, resulta el riesgo de fibrosis hepática por FIB4 score, y NAFLD, bajo en un 73%, y 7.97%, intermedio en un 21.7%, y 31.88% respectivamente, alto 2.9%, 3.62%. En cuanto a los hallazgos por Elastografía transitoria representando el 15% de la muestra, la presencia de fibrosis mínima fue de un 85.71%, avanzada 9.52%. significativa 4.76%. En cuanto a la semejanza en el grado de fibrosis y riesgo por los Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia, due to a defect in insulin secretion, a defect in insulin action, or both. In addition to hyperglycemia, alterations in fat and protein metabolism coexist. Sustained hyperglycemia over time is associated with damage, dysfunction, and failure of several organs and systems, in the case we will address the liver. Fatty liver disease due to metabolic dysfunction (MAFLD) is one of the most frequent complications in DM2 (50-70%), surpassing the prevalence of nephropathy, retinopathy, and diabetic neuropathy. As well as MAFLD that doubles the probability of developing DM2. Liver fibrosis is the healing process that represents the liver's response to injury. by deposing collagen and other components of the matrix. Over time, this process can result in cirrhosis of the liver, in which the architectural organization of the liver's functional units is so altered that blood flow through the liver and liver function are disrupted. Once cirrhosis has developed, serious complications of liver disease can occur, such as portal hypertension, liver failure, and liver cancer. it is important to prevent progression to liver fibrosis in patients with multiple complications, with MASLD being more frequent than expected. Among the non-invasive markers is the fib-4 test, which estimates the degree of liver fibrosis and allows 87% of patients with advanced liver fibrosis to be correctly classified and thus avoid biopsy with 71% accuracy. A negative predictive value of fibrosis of 90% and a positive predictive value of 65% were detected at the established cut-off points. Methodology: An observational, descriptive, correlational, retrospective cross-sectional study is carried out with the aim of determining the degree of risk of developing liver fibrosis in patients with type 2 Diabetes Mellitus with steatotic liver disease associated with metabolic dysfunction using non-invasive methods, at the National Institute of Diabetes, Endocrinology and Nutrition (INDEN) during the period November 2023-April 2024.Results: From the data obtained, the risk of liver fibrosis by FIB4 score, and NAFLD, low by 73%, and 7.97%, intermediate by 21.7%, and 31.88% respectively, high 2.9%, 3.62%. Regarding the findings by transient elastography representing 15% of the sample, the presence of minimal fibrosis was 85.71%, advanced 9.52%. significant 4.76%. Regarding the similarity in the degree of fibrosis and risk by the 3 methods: 83% minimal fibrosis with low risk, 17% with significant fibrosis intermediate risk 3 métodos: 83% fibrosis mínima con bajo riesgo, 17% con fibrosis significativa riesgo intermedio. // [English] Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia, due to a defect in insulin secretion, a defect in insulin action, or both. In addition to hyperglycemia, alterations in fat and protein metabolism coexist. Sustained hyperglycemia over time is associated with damage, dysfunction, and failure of several organs and systems, in the case we will address the liver. Fatty liver disease due to metabolic dysfunction (MAFLD) is one of the most frequent complications in DM2 (50-70%), surpassing the prevalence of nephropathy, retinopathy, and diabetic neuropathy. As well as MAFLD that doubles the probability of developing DM2. Liver fibrosis is the healing process that represents the liver's response to injury. by deposing collagen and other components of the matrix. Over time, this process can result in cirrhosis of the liver, in which the architectural organization of the liver's functional units is so altered that blood flow through the liver and liver function are disrupted. Once cirrhosis has developed, serious complications of liver disease can occur, such as portal hypertension, liver failure, and liver cancer. it is important to prevent progression to liver fibrosis in patients with multiple complications, with MASLD being more frequent than expected. Among the non-invasive markers is the fib-4 test, which estimates the degree of liver fibrosis and allows 87% of patients with advanced liver fibrosis to be correctly classified and thus avoid biopsy with 71% accuracy. A negative predictive value of fibrosis of 90% and a positive predictive value of 65% were detected at the established cut-off points. Methodology: An observational, descriptive, correlational, retrospective cross-sectional study is carried out with the aim of determining the degree of risk of developing liver fibrosis in patients with type 2 Diabetes Mellitus with steatotic liver disease associated with metabolic dysfunction using non-invasive methods, at the National Institute of Diabetes, Endocrinology and Nutrition (INDEN) during the period November 2023-April 2024.Results: From the data obtained, the risk of liver fibrosis by FIB4 score, and NAFLD, low by 73%, and 7.97%, intermediate by 21.7%, and 31.88% respectively, high 2.9%, 3.62%. Regarding the findings by transient elastography representing 15% of the sample, the presence of minimal fibrosis was 85.71%, advanced 9.52%. significant 4.76%. Regarding the similarity in the degree of fibrosis and risk by the 3 methods: 83% minimal fibrosis with low risk, 17% with significant fibrosis intermediate risk