A Pragmatic Approach Identifies a High Rate of Nonalcoholic Fatty Liver Disease With Advanced Fibrosis in Diabetes Clinics and At‐Risk Populations in Primary Care

Autor: PreyaJanubhai Patel, Fabrina Hossain, Leigh Ula Horsfall, Xuan Banh, Kelly Lee Hayward, Suzanne Williams, Tracey Johnson, Anne Bernard, Nigel Neil Brown, Guy Lampe, Lyndall Buck, Nivene Saad, Anthony William Russell, Patricia Casarolli Valery, Katharine Margaret Irvine, Andrew Donald Clouston, Katherine Anne Stuart, William Rosenberg, Elizabeth Ellen Powell
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: Hepatology Communications, Vol 2, Iss 8, Pp 897-909 (2018)
Druh dokumentu: article
ISSN: 2471-254X
DOI: 10.1002/hep4.1208
Popis: Noninvasive serum biomarkers (nonalcoholic fatty liver disease fibrosis score [NFS], fibrosis 4 score [FIB‐4], or enhanced liver fibrosis [ELF] test) are recommended as first‐line tools to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease. We aimed to assess the utility of a pragmatic approach to screening for clinically significant fibrosis in primary care and diabetes clinics. We recruited 252 patients from an endocrine clinic or primary care facility. Anthropometric measurements, ELF test, ultrasound, and liver stiffness measurements (LSMs) were performed. Clinically significant fibrosis was defined as LSM ≥8.2 kPa or ELF ≥9.8. A subgroup of patients underwent liver biopsy (n = 48) or had imaging diagnostic of cirrhosis (n = 14). Patients were 57.3 ± 12.3 years old with a high prevalence of metabolic syndrome (84.5%), type 2 diabetes (82.5%), and body mass index (BMI) ≥40 kg/m2 (21.8%). LSM met quality criteria in 230 (91.3%) patients. NFS and FIB‐4 combined had a high negative predictive value (90.0%) for excluding LSM ≥8.2 kPa. However, 84.1% of patients had indeterminate or high NFS or FIB‐4 scores requiring further assessment. LSM ≥8.2 kPa and ELF ≥9.8 were present in 31.3% and 28.6% of patients, respectively. Following adjustment for age, BMI, sex, and presence of advanced fibrosis, older age was independently associated with ELF ≥9.8 (adjusted odds ratio, 1.14; 95% confidence interval, 1.06‐1.24), whereas increasing BMI was independently associated with LSM ≥8.2 kPa (adjusted odds ratio, 1.15; 95% confidence interval, 1.01‐1.30). Concordant LSM
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