Identification of High-Risk Patients With Nonalcoholic Fatty Liver Disease Using Noninvasive Tests From Primary Care and Endocrinology Real-World Practices
| Autor: | Fatema Nader, Rebecca Cable, Marc Bailey, Yasser Ousman, Huong Pham, Sean Felix, Arian Afendy, Elena Younossi, Evis Hudson, Zahra Younoszai, Brian Lam, Pratima Fozdar, Nila Rafiq, Nahrain Alzubaidi, Zik Chris, Pegah Golabi, Ingrid Schneider, Maria Stepanova, Maria Ramirez, Hussain Allawi, Thomas Jeffers, Zobair M. Younossi, Mariam Afendy, Mehreen Husain, Maria Castillo-Catoni |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Type 2 diabetes Primary care Article Body Mass Index 03 medical and health sciences Endocrinology 0302 clinical medicine Liver Function Tests Non-alcoholic Fatty Liver Disease Risk Factors Fibrosis Internal medicine Nonalcoholic fatty liver disease medicine Electronic Health Records Humans Referral and Consultation Aged High risk patients Primary Health Care business.industry Metabolic risk Gastroenterology Middle Aged medicine.disease Liver 030220 oncology & carcinogenesis Elasticity Imaging Techniques Female 030211 gastroenterology & hepatology Transient elastography business Body mass index Algorithms Biomarkers |
| Zdroj: | Clinical and Translational Gastroenterology |
| ISSN: | 2155-384X |
| DOI: | 10.14309/ctg.0000000000000340 |
| Popis: | INTRODUCTION: We aimed to identify high-risk nonalcoholic fatty liver disease (NAFLD) patients seen at the primary care and endocrinology practices and link them to gastrohepatology care. METHODS: Using the electronic health record, patients who either had the diagnosis of type 2 diabetes or had 2 of 3 other metabolic risk factors met criteria for inclusion in the study. Using noninvasive fibrosis tests (NITs) to identify high risk of fibrosis, patients who met the NIT prespecified criteria were referred to gastrohepatology for clinical assessment and transient elastography. RESULTS: From 7,555 patients initially screened, 1707 (22.6%) met the inclusion criteria, 716 (42%) agreed to enroll, and 184 (25.7%) met the prespecified NIT criteria and eligibility for linkage to GE-HEP where 103 patients (68 ± 9 years of age, 50% men, 56% white) agreed to undergo linkage assessments. Their NIT scores were APRI of 0.38 ± 0.24, FIB-4 of 1.98 ± 0.87, and NAFLD Fibrosis Score of 0.36 ± 1.03; 68 (66%) linked patients had controlled attenuation parameter >248 dB/m, 62 (60%) had liver stiffness 12 kPa. Liver stiffness for the overall group was 6.7 ± 4.2 kPa, controlled attenuation parameter 282 ± 64 dB/m, and FAST score 0.22 ± 0.22. Linked patients with presumed advanced fibrosis had significantly higher body mass index (36.4 ± 6.6 vs 31.2 ± 6.4 kg/m2, P = 0.025) and higher NIT scores (APRI 0.89 ± 0.52 vs 0.33 ± 0.14, FIB-4 3.21 ± 2.06 vs 1.88 ± 0.60, and NAFLD Fibrosis Score 1.58 ± 1.33 vs 0.25 ± 0.94). DISCUSSION: By applying a simple prespecified multistep algorithm using electronic health record with clinical risk factors and NITs followed by transient elastography, patients with nonalcoholic fatty liver disease seen in PCP and ENDO practices can be easily identified. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|