Taking a risk-based approach to testing for liver disease in primary care, a step in the right direction

Rowe, Ian; D’Amico, Gennaro

doi:10.1016/j.jhep.2022.03.038

Cited by 3 publications

(4 citation statements)

References 21 publications

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“… 12 Identifying patients in primary care who will benefit the most from specialist referral for further assessment remains a challenge, and there is debate about the best approach. 13 …”

Section: Introductionmentioning

confidence: 99%

“…[12] Identifying patients in primary care who will benefit the most from specialist referral for further assessment remains a challenge, and there is debate about the best approach. [13] This study evaluates the use of a novel information technology cloud-based software solution, which accesses medical records of general practices and uses existing clinical information and laboratory results to identify patients who are at increased risk of ACLD. The aim of this study is to assess if this approach is effective in detecting patients with undiagnosed ACLD and linking them to specialist care.…”

Section: Introductionmentioning

confidence: 99%

“…However, it is known that even minor abnormalities in liver function biochemistry can be associated with a higher risk of long-term mortality 12 . Identifying patients in primary care who will benefit the most from specialist referral for further assessment remains a challenge, and there is debate about the best approach 13 …”

Section: Introductionmentioning

confidence: 99%

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Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Prince,

Hoque,

Kim

et al. 2024

Hepatology Communications

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Background: Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression. Methods: A cloud-based software solution (“the Liver Toolkit”) was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded. Results: Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0–9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction–associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041). Conclusions: This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.

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“… 12 Identifying patients in primary care who will benefit the most from specialist referral for further assessment remains a challenge, and there is debate about the best approach. 13 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Prince,

Hoque,

Kim

et al. 2024

Hepatology Communications

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“…Such information is important as most patients with MASLD will never develop liver-related outcomes (7). Hence, a risk-based approach to screening or treatment has been advocated for (8,9). That is, instead of solely aiming to diagnose MASLD or fibrosis, one considers the risk a patient has for future liverrelated outcomes and tailors appropriate actions accordingly.…”

mentioning

confidence: 99%

Metabolic Syndrome Traits Increase the Risk of Major Adverse Liver Outcomes in Type 2 Diabetes

Shang,

Grip,

Modica

et al. 2024

Diabetes Care

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OBJECTIVE Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALOs), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is a synergistic effect of accumulating MetS traits on future MALO risk. RESEARCH DESIGN AND METHODS Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until 31 October 2022. Data were analyzed using Cox regression models. RESULTS In total, 230,992 patients were identified (median age 64 years; 58% male), of whom 3,215 (1.39%) developed MALOs over a median follow-up of 9.9 years. Compared with patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALOs (adjusted hazard ratio [aHR] 2.33, 95% CI 1.53–3.54). The rate of MALOs increased progressively with increasing numbers of MetS traits at baseline (aHR 1.28 per added trait, 95% CI 1.23–1.33). During follow-up, patients who acquired additional MetS traits had a progressively higher rate of MALOs. The MetS trait with the largest association with incident MALOs was hypertension (aHR 2.06, 95% CI 1.57–2.71). CONCLUSIONS Having or acquiring additional traits of MetS increase the rate of progression to MALOs in patients with T2D. These results could be used to inform screening initiatives for liver disease.

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Reply to: “Prediction of liver-related mortality in a community setting”

Innes

Guha

2023

Journal of Hepatology

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Taking a risk-based approach to testing for liver disease in primary care, a step in the right direction

Cited by 3 publications

References 21 publications

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Metabolic Syndrome Traits Increase the Risk of Major Adverse Liver Outcomes in Type 2 Diabetes

Reply to: “Prediction of liver-related mortality in a community setting”

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