Identifying and Linking Patients At Risk for MASLD with Advanced Fibrosis to Care in Primary Care.

Autor: Xiao TG; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Witek L; Informatics and Analytics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Bundy RA; Informatics and Analytics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Moses A; Informatics and Analytics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Obermiller CS; Informatics and Analytics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Schreiner AD; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA., Dharod A; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Informatics and Analytics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Department of Implementation Science, Division of Public Health Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Wake Forest Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Wake Forest Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC, USA., Russo MW; Division of Liver Diseases and Transplant, Atrium Health Carolina Medical Center, Charlotte, NC, USA., Rudnick SR; Section of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston-Salem, NC, USA. srudnick@wakehealth.edu.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Jul 26. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1007/s11606-024-08955-9
Abstrakt: Background and Aims: Severity of fibrosis is the driver of liver-related outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD), and non-invasive testing such as fibrosis-4 (FIB-4) score is utilized for risk stratification. We aimed to determine if primary care patients at risk for MASLD and advanced fibrosis were evaluated with subsequent testing. A secondary aim was to determine if at-risk patients with normal aminotransferases had advanced fibrosis.
Methods: Primary care patients at increased risk for MASLD with advanced fibrosis (n = 91,914) were identified using previously established criteria. Patients with known alternative/concomitant etiology of liver disease or cirrhosis were excluded. The study cohort included patients with calculated FIB-4 score in 2020 (n = 52,006), and stratified into low, indeterminate, and high likelihood of advanced fibrosis. Among those at indeterminate/high risk, rates of subsequent testing were measured.
Results: Risk stratification with FIB-4 characterized 77% (n = 40,026) as low risk, 17% (n = 8847) as indeterminate, and 6% (n = 3133) as high risk. Among indeterminate/high-risk patients (n = 11,980), 78.7% (n = 9433) had aminotransferases within normal limits, 0.95% (n = 114) had elastography, and 8.2% (n = 984) were referred for subspecialty evaluation.
Conclusion: In this cohort of primary care patients at risk for MASLD with fibrosis, the FIB-4 score identified a substantial proportion of indeterminate/high-risk patients, the majority of which had normal aminotransferase levels. Low rates of subsequent testing were observed. These data suggest that a majority of patients at increased risk for liver-related outcomes remain unrecognized and highlight opportunities to facilitate their identification.
(© 2024. The Author(s).)
Databáze: MEDLINE
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