The fibrosis investigating navigator in diabetes (FIND): A tool to predict liver fibrosis risk in subjects with diabetes

Abstract Background Type 2 diabetes increases the risk of cirrhosis and liver cancer. Noninvasive and early assessment of liver fibrosis is essential. We aimed to develop a score to aid in the initial assessment of liver fibrosis in the diabetic population. Methods A fibrosis investigating navigator in diabetes (FIND) score was developed and validated in the NHANES dataset (2017–2020). Fibrosis was defined as a liver stiffness measurement (LSM) ≥8.0 kPa. The diagnostic accuracies of FIB‐4, NFS, LiverRisk, steatosis‐associated fibrosis estimator (SAFE) and metabolic dysfunction–associated fibrosis (MAF‐5) were compared. FIND was also externally validated in various liver diseases via biopsy as a reference in an Asian centre between 2016 and 2020. Finally, we examined the prognostic implications of the FIND index utilizing data from the UK Biobank cohort (2006–2010). Results The FIND score model yielded an AUROC of 0.781 for the prediction of an LSM ≥8 kPa in the validation set, which was consistently greater than that of other available models (all p < 0.05). In the whole NHANES dataset, the 85% sensitivity cut‐off of 0.16 corresponded to a NPV of 91.9%, whereas the 85% specificity cut‐off of 0.31 corresponded to a PPV of 50.6%. FIND displayed overall accuracies similar to those of the other models in staging fibrosis stages, with biopsy used as a reference. In the UK Biobank cohort, FIND >0.31 was associated with an increased risk of all‐cause and liver‐related mortality in the diabetic population in adjusted models (HR, 1.75; 95% CI, 1.62–1.89; HR, 23.59; 95% CI, 13.67–40.69). Conclusions In diabetes patients, the novel FIND score performs well in identifying subjects at risk of liver fibrosis and predicting all‐cause and liver‐related mortality.