Using non-invasive indicators to screen the PCOS population for liver disease - a single-centre study

Abstract

Introduction: Studies show an association between polycystic ovary syndrome (PCOS) and an increased incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) in this patient group. Diagnostic tools that can screen relevant groups of PCOS' patients for liver disease are still being sought.

Material and methods: Our study included 242 patients with PCOS diagnosed on the basis of the Rotterdam criteria, which we divided according to phenotypes. Using the Fibrosis-4 (FIB-4) and BAAT (BMI, age, ALT, triglycerides) calculators, we conducted screening for liver disease in each group of patients. In addition, we compared the results of anthropometric measurements, androgen serum levels, and Homeostatic Model Assessment - Insulin Resistance (HOMA-IR) index in each group.

Results: The values of the FIB-4 and BAAT indices in this study are small regardless of phenotype. A notably significant difference in FIB-4 was found only between phenotypes A and B (p = 0.01). The median of the FIB-4 index among patients with phenotype B was Me:-0.51; interquartile range (IQR): 0.22. The median of FIB-4 index among patients with phenotype A was Me: -0.41; IQR: 0.18. The groups of PCOS patients divided by phenotypes based on the BAAT index are similar, a difference that was statistically insignificant (p = 0.3). The lowest levels of insulin were noted in phenotype C, and it was significantly different from levels of insulin in phenotype B. The multiple comparisons for levels of glucose and HOMA-IR were not significantly different.

Conclusions: The probability of liver fibrosis in the PCOS patients examined on the basis of both the FIB-4 and BAAT indices is low, which is probably due to the young age of the subjects. Higher FIB-4 index results were obtained in the group of patients with phenotype B compared to the group with phenotype A, and the group with phenotype B was similar to the groups with phenotype C and D. Moreover, based on our results, we demonstrated lower level of insulin in phenotype C compared to the group with phenotype B. The BAAT index result proved to be statistically insignificant in the studied patients, with a breakdown by PCOS phenotype.

Keywords: BAAT; FIB-4; HOMA-IR; metabolic dysfunction-associated steatotic liver disease; polycystic ovary syndrome.