Embedding assessment of liver fibrosis into routine diabetic review in primary care

Autor: Stuart McPherson, Marc Herscovitz, Jonathan Vernazza, Quentin M. Anstee, Dina Mansour, Andrea Broad, Paul Cassidy, Allison Grapes
Jazyk: angličtina
Rok vydání: 2021
Předmět:
medicine.medical_specialty
NAFLD
non-alcoholic fatty liver disease
Cirrhosis
Transient elastography
EASL
European Association for the Study of the Liver
LFTs
liver function tests
NASH
non-alcoholic steatohepatitis
LSM
liver stiffness measurement
Type 2 diabetes
AST
aspartate aminotransferase
RC799-869
ELF
enhanced liver fibrosis test
Liver disease
T2DM
type 2 diabetes
Diabetes mellitus
Internal medicine
ALT
alanine aminotransferase
Type 2 diabetes mellitus
Internal Medicine
medicine
Immunology and Allergy
GGT
gamma-glutamyl transferase
Non-invasive
Hepatology
medicine.diagnostic_test
ALP
alkaline phosphatase
business.industry
Fatty liver
Gastroenterology
Odds ratio
Serum biomarkers
Diseases of the digestive system. Gastroenterology
medicine.disease
Fibrosis
TE
transient elastography
OR
odds ratio
HbA1c
glycated haemoglobin
Liver function tests
business
HCC
hepatocellular carcinoma
Liver stiffness
Research Article
Non-alcoholic fatty liver disease
Zdroj: JHEP Reports, Vol 3, Iss 4, Pp 100293-(2021)
JHEP Reports
ISSN: 2589-5559
Popis: Background & Aims Individuals with type 2 diabetes (T2DM) are at high risk of developing non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis/cirrhosis. Screening patients with T2DM and normal liver enzymes for NAFLD in primary care remains contentious. Our aim was to develop and assess a primary care pathway integrating two-tier (Fib-4 then transient elastography [TE]) liver fibrosis assessment, irrespective of aetiology, into routine annual review of all patients with T2DM. Methods All patients aged >35 years with T2DM attending annual review at 2 primary care practices in North East England between April 2018 and September 2019 (n = 467) had Fib-4 requested via the electronic patient record. Those with a Fib-4 score above the ‘high-sensitivity’ threshold (>1.3 for ≤65 years and >2.0 for >65 years) underwent TE and were reviewed in secondary care if the liver stiffness measurement (LSM) was >8 kPa. The number of patients identified with advanced disease, service uptake, and predictors of advanced disease were assessed. Results A total of 85/467 (18.5%) patients had raised Fib-4; 27/467(5.8%) were excluded as a result of frailty or known cirrhosis. A total of 58/467 (12.2%) were referred for TE. Twenty-five of 58 (43.1%) had an LSM of >8 kPa and 13/58 (22.4%) had an LSM >15 kPa; 4/58 (6.7%) did not attend and 5/58 (9.3%) had an invalid reading. Twenty of 440 (4.5%) patients were found to have advanced liver disease following specialist review, compared to 3 patients previously identified through standard care (odds ratio [OR] 6.71 [2.0–22.7] p = 0.0022). Alcohol (OR 1.05 [1.02–1.08] p = 0.001) and BMI (OR 1.09 [1.01–1.17] p = 0.021) were predictors of advanced disease, particularly drinking >14/21 units/week (p
Graphical abstract
Highlights • People with type 2 diabetes are at increased risk of advanced liver fibrosis, exacerbated by excess alcohol consumption. • Incorporating a 2-step fibrosis assessment into primary care diabetes review increased advanced fibrosis detection 7-fold. • Fib-4 scores automatically calculated at diabetic review in primary care and results displayed with advisory comments. • Almost half the patients identified with advanced liver disease had alanine transferase below the laboratory cut-off. • This pathway could improve detection of advanced liver disease in individuals with type 2 diabetes in primary care.
Databáze: OpenAIRE
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