Embedding assessment of liver fibrosis into routine diabetic review in primary care
| العنوان: | Embedding assessment of liver fibrosis into routine diabetic review in primary care |
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| المؤلفون: | Stuart McPherson, Marc Herscovitz, Jonathan Vernazza, Quentin M. Anstee, Dina Mansour, Andrea Broad, Paul Cassidy, Allison Grapes |
| المصدر: | JHEP Reports, Vol 3, Iss 4, Pp 100293-(2021) JHEP Reports |
| بيانات النشر: | Elsevier, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | 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 |
| الوصف: | 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. |
| اللغة: | English |
| تدمد: | 2589-5559 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1336cef2de43968549cc7d868da73a54Test http://www.sciencedirect.com/science/article/pii/S2589555921000690Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1336cef2de43968549cc7d868da73a54 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 25895559 |
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