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Gaps in Confirmatory Fibrosis Risk Assessment in Primary Care Patients with Nonalcoholic Fatty Liver Disease

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Abstract

Background

As recommendations for non-invasive fibrosis risk assessment in nonalcoholic fatty liver disease (NAFLD) emerge, it is not known how often they are performed in primary care.

Aims

We investigated the completion of confirmatory fibrosis risk assessment in primary care patients with NAFLD and indeterminate-risk or greater Fibrosis-4 Index (FIB-4) and NAFLD Fibrosis Scores (NFS).

Methods

This retrospective cohort study of electronic health record data from a primary care clinic identified patients with diagnoses of NAFLD from 2012 through 2021. Patients with a diagnosis of a severe liver disease outcome during the study period were excluded. The most recent FIB-4 and NFS scores were calculated and categorized by advanced fibrosis risk. Charts were reviewed to identify the outcome of a confirmatory fibrosis risk assessment by liver elastography or liver biopsy for all patients with indeterminate-risk or higher FIB-4 (≥ 1.3) and NFS (≥ − 1.455) scores.

Results

The cohort included 604 patients diagnosed with NAFLD. Two-thirds of included patients (399) had a FIB-4 or NFS score greater than low-risk, 19% (113) had a high-risk FIB-4 (≥ 2.67) or NFS (≥ 0.676) score, and 7% (44) had high-risk FIB-4 and NFS values. Of these 399 patients with an indication for a confirmatory fibrosis test, 10% (41) underwent liver elastography (24) or liver biopsy (18) or both (1).

Conclusions

Advanced fibrosis is a key indicator of future poor health outcomes in patients with NAFLD and a critical signal for referral to hepatology. Significant opportunities exist to improve confirmatory fibrosis risk assessment in patients with NAFLD.

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Data availability

The study protocol and individual participant data contributing to these reported results reported in this article will be made available to investigators whose proposed use of the data have been approved by an independent review committee. Data will only be made available after de-identification (text, tables, figures, and appendices) and compliance with the Health Insurance Portability and Accountability Act of 1996 and the Institutional Review Board at MUSC is assured.

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Funding

Effort and time for this study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK K23DK118200 PI: Schreiner; R03DK129558 PI: Schreiner; P30DK123704 PI: Rockey). This project is also supported in part by the SSCI Research Scholar Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Southern Society for Clinical Investigation (SSCI). This project was also supported by the South Carolina Clinical & Translational Research Institute with an academic home at the Medical University of South Carolina CTSA National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under UL1 TR001450.

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Authors and Affiliations

  1. Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA

    Joseph A. Moore, William H. Wheless, Jingwen Zhang, Justin Marsden, Patrick D. Mauldin, William P. Moran & Andrew D. Schreiner

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  1. Joseph A. Moore
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  2. William H. Wheless
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  3. Jingwen Zhang
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  4. Justin Marsden
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Contributions

All contributors to this work appear in the author byline. All named authors contributed to the study design, data interpretation, manuscript editing, and submission decision. Dr. ADS and Ms. JZ led the writing of the original draft, and Ms. JZ performed the analyses. Ms. JZ, Mr. JM, and Dr. ADS performed the data collection.

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Correspondence to Andrew D. Schreiner.

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Appendix

Appendix

(See Table 4).

Table 4 ICD-9/10 codes for severe liver disease outcomes and chronic liver disease diagnoses [24,25,26]
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Moore, J.A., Wheless, W.H., Zhang, J. et al. Gaps in Confirmatory Fibrosis Risk Assessment in Primary Care Patients with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 68, 2946–2953 (2023). https://doi.org/10.1007/s10620-023-07959-5

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