Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease
| Autor: | Deepak Suri, S. Morgan, William Rosenberg, Douglas Thorburn, Julie Parkes, R. Gailer, Sudeep Tanwar, Ankur Srivastava, Emmanuel Tsochatzis, K. Sennett, Alison Rodger, P M Trembling |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Liver Cirrhosis Male 0301 basic medicine medicine.medical_specialty Cirrhosis Cost effectiveness Population steatohepatitis Disease 03 medical and health sciences Liver disease 0302 clinical medicine Liver Function Tests Non-alcoholic Fatty Liver Disease Internal medicine non-invasive fibrosis test medicine Humans Longitudinal Studies Prospective Studies education Referral and Consultation Aged education.field_of_study Hematologic Tests Primary Health Care Hepatology business.industry cirrhosis Fatty liver Odds ratio Middle Aged medicine.disease ELF 030104 developmental biology FIB-4 Female 030211 gastroenterology & hepatology Steatohepatitis business Algorithms |
| Zdroj: | Srivastava, A, Gailer, R, Tanwar, S, Trembling, P, Parkes, J, Rodger, A, Suri, D, Thorburn, D, Sennett, K, Morgan, S, Tsochatzis, E A & Rosenberg, W 2019, ' Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. ', Journal of Hepatology, vol. 71, no. 2 . https://doi.org/10.1016/j.jhep.2019.03.033 |
| ISSN: | 0168-8278 |
| DOI: | 10.1016/j.jhep.2019.03.033 |
| Popis: | Background & Aims: the development of non-invasive liver fibrosis tests may enable earlier identification of patients with non-alcoholic fatty liver disease (NAFLD) requiring referral to secondary care. We developed and evaluated a pathway for the management of patients with NAFLD, aimed at improving the detection of cases of advanced fibrosis and cirrhosis, and avoiding unnecessary referrals. Methods: this was a prospective longitudinal cohort study, with analyses performed before and after introduction of the pathway, and comparisons made to unexposed controls. We used a 2-step algorithm combining the use of Fibrosis-4 score followed by the ELF™ test if required. Results: in total, 3,012 patients were analysed. Use of the pathway detected 5 times more cases of advanced fibrosis (Kleiner F3) and cirrhosis (odds ratio [OR] 5.18; 95% CI 2.97–9.04; p Conclusions: the use of non-invasive blood tests for liver fibrosis improves the detection of advanced fibrosis and cirrhosis, while reducing unnecessary referrals in patients with NAFLD. This strategy improves resource use and benefits patients. Lay summary: Non-alcoholic fatty liver disease effects up to 30% of the population but only a minority of cases develop liver disease. Our study has shown that established blood tests can be used in primary care to stratify patients with fatty liver disease, leading to a reduction in unnecessary referrals by 80% and greatly improving the detection of cases of advanced fibrosis and cirrhosis. |
| Databáze: | OpenAIRE |
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