TBA (22W152)

An audit of risk assessment for fibrosis in patients with NAFLD: We can do better

Author(s)

C. Linehan1, A Wagener1, G McAuliffe3, L Barry1, C O Boyle2,4, L Jackson1,4, D Houlihan1,4& W Stack1,4

Department(s)/Institutions

Department of Gastroenterology & Gastro-intestinal Physiology, Bon Secours Hospital, Cork1, Department of GI Surgery, Bon Secours Hospital, Cork2, Department of Radiology, Bon Secours Hospital,Cork3, School of Medicine, University College Cork4.

Introduction

Current guidelines recommend risk assessment of patients with fatty liver disease (FLD) where early intervention could prevent evolution to liver cirrhosis.

Aims/Background

To determine if patients with fatty liver disease are being risk assessed for fibrosis.

Method

Retrospective chart review on 73 consecutive patients with FLD based on increased liver echogenicity consistent with fatty infiltration were identified at ultrasound

Results

73 consecutive patients had an echogenic (fatty) liver on US (38F, 34M) mean age 57.22 (19-87). 10 were excluded from analysis (6 hepatoma surveillance, 4 incomplete records). Of 63 patients, mean BMI was 33.8 (22.6-59.8). 9(25%) had DM, 34(53.9%) hypertension and 25 (39.6 % ), hypercholesteremia . No patient had risk scores performed by bloods (FIB-4 or other), 20 of 63 (31.7%) had a FibroScan at any time. Of 12 patients fitting criteria for metabolic syndrome only 4 (33%) were referred for FibroScan. FIB-4 was retrospectively calculated for 51 patients (12 had incomplete data to allow this), 16 of 51(33%) had FIB-4 index of > 1.45 indicating significant fibrosis where hepatology follow up with FibroScan is recommended. Only 7 of these patients had FibroScan. Three patients had FIB-4 index > 3.25 (high risk of fibrosis) and one of these patients (33%) was was referred for a FibroScan.

Conclusions

This audit confirms our suspicion that guidelines in relation to risk assessment for fibrosis in fatty liver disease are not being adequately followed with only one third of patients undergoing appropriate assessment.