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Peer-reviewedCC BY 4.0Cureus

Diagnostic Performance of Triglyceride-Glucose Body Mass Index (TyG-BMI), Fibrosis-4 Index (FIB-4), and Their Combined Model for Clinically Significant Liver Fibrosis in Type 2 Diabetes Mellitus

  • Tahseer Khan1
  • Syeda Batool Tirmizi1
  • Aamir Shehzad2
  • Arslan Shamim3
  • Zara Ramzan4
  • Ahsan Raza5
  • Sarah Khan6,7
7 affiliations
  1. 1Internal Medicine, Dow University Hospital, Karachi, PAK
  2. 2Gastroenterology, Lahore General Hospital, Lahore, Lahore, PAK
  3. 3Internal Medicine, Ghurki Trust Teaching Hospital, Lahore, PAK
  4. 4Nephrology, Services Hospital Lahore, Lahore, PAK
  5. 5Emergency Medicine, Government Trauma Centre Lalamusa, Lalamusa, PAK
  6. 6Acute Medicine, William Harvey Hospital, East Kent Hospitals University Foundation Trust, Ashford, GBR
  7. 7Internal Medicine, Shaikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
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Abstract

Introduction

Patients with type 2 diabetes mellitus are at increased risk of clinically significant liver fibrosis, while commonly used noninvasive fibrosis scores do not perform equally well in all patients. The triglyceride-glucose body mass index (TyG-BMI) captures metabolic changes and excess body weight and may add information not included in the fibrosis-4 index (FIB-4). This study assessed how well the TyG-BMI and FIB-4 identified clinically significant liver fibrosis when used alone and together.

Methods

This cross-sectional diagnostic accuracy study included 280 patients with type 2 diabetes mellitus. The TyG-BMI and FIB-4 were calculated using the patients’ clinical and laboratory measurements. Transient elastography served as the reference test, with liver stiffness measurement ≥8 kPa used to identify clinically significant fibrosis. Accuracy was assessed by receiver operating characteristic analysis and by calculating sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.

Results

Clinically significant liver fibrosis was present in 66 of 280 patients (23.6%). The TyG-BMI showed moderate discrimination, with an area under the curve (AUC) of 0.710 (95% CI 0.633-0.783), while the FIB-4 showed an AUC of 0.801 (95% CI 0.736-0.857). At a FIB-4 cutoff of 1.30, sensitivity was 78.8%, specificity was 69.2%, and negative predictive value was 91.4%. The combined TyG-BMI-FIB-4 model achieved an AUC of 0.850 (95% CI 0.796-0.901), with 78.8% sensitivity, 79.0% specificity, 53.6% positive predictive value, 92.3% negative predictive value, and 78.9% accuracy. The internally validated AUC was 0.845.

Conclusions

Combining the TyG-BMI with the FIB-4 improved discrimination for transient elastography-defined clinically significant liver fibrosis compared with either index alone. This approach may improve noninvasive fibrosis risk stratification in patients with type 2 diabetes mellitus, but external validation is required before clinical application.

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Cite

BibTeXRIS
BibTeX
@article{khan2026diagnostic,
  title = {{Diagnostic Performance of Triglyceride-Glucose Body Mass Index (TyG-BMI), Fibrosis-4 Index (FIB-4), and Their Combined Model for Clinically Significant Liver Fibrosis in Type 2 Diabetes Mellitus}},
  author = {Tahseer Khan and Syeda Batool Tirmizi and Aamir Shehzad and Arslan Shamim and Zara Ramzan and Ahsan Raza and Sarah Khan},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117491},
  url = {https://doi.org/10.7759/cureus.117491},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diagnostic Performance of Triglyceride-Glucose Body Mass Index (TyG-BMI), Fibrosis-4 Index (FIB-4), and Their Combined Model for Clinically Significant Liver Fibrosis in Type 2 Diabetes Mellitus
AU  - Tahseer Khan
AU  - Syeda Batool Tirmizi
AU  - Aamir Shehzad
AU  - Arslan Shamim
AU  - Zara Ramzan
AU  - Ahsan Raza
AU  - Sarah Khan
PY  - 2026
DA  - 2026/10/05
JO  - Cureus
DO  - 10.7759/cureus.117491
UR  - https://doi.org/10.7759/cureus.117491
AB  - Introduction  Patients with type 2 diabetes mellitus are at increased risk of clinically significant liver fibrosis, while commonly used noninvasive fibrosis scores do not perform equally well in all patients. The triglyceride-glucose body mass index (TyG-BMI) captures metabolic changes and excess body weight and may add information not included in the fibrosis-4 index (FIB-4). This study assessed how well the TyG-BMI and FIB-4 identified clinically significant liver fibrosis when used alone and together.  Methods  This cross-sectional diagnostic accuracy study included 280 patients with type 2 diabetes mellitus. The TyG-BMI and FIB-4 were calculated using the patients’ clinical and laboratory measurements. Transient elastography served as the reference test, with liver stiffness measurement ≥8 kPa used to identify clinically significant fibrosis. Accuracy was assessed by receiver operating characteristic analysis and by calculating sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.  Results  Clinically significant liver fibrosis was present in 66 of 280 patients (23.6%). The TyG-BMI showed moderate discrimination, with an area under the curve (AUC) of 0.710 (95% CI 0.633-0.783), while the FIB-4 showed an AUC of 0.801 (95% CI 0.736-0.857). At a FIB-4 cutoff of 1.30, sensitivity was 78.8%, specificity was 69.2%, and negative predictive value was 91.4%. The combined TyG-BMI-FIB-4 model achieved an AUC of 0.850 (95% CI 0.796-0.901), with 78.8% sensitivity, 79.0% specificity, 53.6% positive predictive value, 92.3% negative predictive value, and 78.9% accuracy. The internally validated AUC was 0.845.  Conclusions  Combining the TyG-BMI with the FIB-4 improved discrimination for transient elastography-defined clinically significant liver fibrosis compared with either index alone. This approach may improve noninvasive fibrosis risk stratification in patients with type 2 diabetes mellitus, but external validation is required before clinical application.
SN  - 2168-8184
ER  -