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J Investig Med. 2018 Oct 10. pii: jim-2018-000864. doi: 10.1136/jim-2018-000864. [Epub ahead of print]

Performance of the SteatoTest, ActiTest, NashTest and FibroTest in a multiethnic cohort of patients with type 2 diabetes mellitus.

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Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA.
Malcom Randall Veterans Administration Medical Center, Quest Diagnostics Nichols Institute, Gainesville, Florida, USA.
Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA.
Biopredictive, Paris, France.
Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.
Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA.


Fibromax is a diagnostic tool composed of the combination of 4 non-invasive biomarker panels for the diagnosis of steatosis (SteatoTest), necrosis and inflammation (ActiTest and NashTest-2) and fibrosis (FibroTest). The purpose of this study was to assess the performance of these biomarker panels in patients with type 2 diabetes mellitus (T2DM). All patients underwent routine labs, a 75 g oral glucose tolerance test, a liver proton magnetic resonance spectroscopy (1H-MRS) to measure intrahepatic triglyceride content, and a percutaneous liver biopsy to establish the diagnosis of non-alcoholic steatohepatitis (NASH) and to grade and stage the disease in those patients with non-alcoholic fatty liver disease (NAFLD) by 1H-MRS. For determination of the scores, plasma samples were blindly provided to establish the SteatoTest, ActiTest, NashTest-2 and FibroTest scores. A total of 220 patients with T2DM were included in this study. When the ability of the SteatoTest to identify patients with T2DM with NAFLD by 1H-MRS was assessed, the overall performance expressed as the area under the receiver operating characteristic curve was 0.73 (95% CI 0.65 to 0.81). The performance of the ActiTest and NashTest-2 to diagnose definite NASH among patients with T2DM was 0.70 (95% CI 0.63 to 0.77) and 0.69 (95% CI 0.62 to 0.76), respectively. Regarding the FibroTest score, its performance to identify patients with moderate or advanced fibrosis was 0.67 (95% CI 0.58 to 0.76) and 0.72 (95% CI 0.61 to 0.83), respectively. Non-invasive panels for the diagnosis of steatosis, NASH and/or fibrosis, which were developed and validated in non-diabetic cohorts, underperformed when applied to a large cohort of patients with T2DM. Results from non-diabetic populations should not be extrapolated to patients with T2DM.


diabetes mellitus; fatty liver; hepatitis; insulin


Conflict of interest statement

Competing interests: MJM and MPC are employees and stock holders of Quest Diagnostics. JMC is full employee of BioPredictive. TP is the inventor of the tests assessed in the study and founder of BioPredictive. The patents belong to the public organization Asssitance Publique Hôpitaux de Paris.

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