Angiotensin II as a Diagnostic Tool for Liver Fibrosis in Patients with Diabetes Mellitus

Abstract

Background: Liver fibrosis is a common complication of diabetes mellitus (DM) that may progress to cirrhosis and hepatocellular carcinoma. Angiotensin II plays an important role in hepatic fibrogenesis and has been proposed as a potential biomarker for early detection of liver fibrosis. This study aimed to evaluate the diagnostic performance of serum angiotensin II for detecting liver fibrosis using the Fibrosis-4 (FIB-4) index as the reference standard. Methods: A cross-sectional study was conducted in Purwokerto, Indonesia, between February and March 2021 involving 61 patients with DM. Liver fibrosis was defined as a FIB-4 score ≥1.43. Serum angiotensin II levels were measured by ELISA, and diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis to determine the optimal cut-off value, area under the ROC curve (AUROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Results: The participants had a mean age of 60.3 ± 6.2 years, and 32.8% were classified as having liver fibrosis based on the FIB-4 index. The optimal cut-off value of serum angiotensin II was 728.83 pg/mL. The AUROC was 0.60 (95% CI: 0.45–0.76; p = 0.186), with a sensitivity of 60%, specificity of 61%, PPV of 42.9%, NPV of 75.8%, positive likelihood ratio of 1.54, and negative likelihood ratio of 0.66, indicating limited diagnostic performance. Conclusions: Serum angiotensin II demonstrated limited diagnostic accuracy for detecting liver fibrosis in patients with DM. Although it may have potential as an adjunctive non-invasive screening biomarker, its clinical utility requires further validation in larger prospective studies using validated reference standards