TBA (21W138)

Community NAFLD screening programme in patients with T2DM indicates high burden of undiagnosed liver disease.

Author(s)

McCormick E (1), Cullen N (1), O’Hagan O (2), Norris S (1)

Department(s)/Institutions

1. Department of Hepatology, St James's Hospital, Dublin 8 2. Meagher's Pharmacy Group, Dublin

Introduction

NAFLD is the most common liver disease in Western countries, affecting 1 in 4 adults. Hepatic fibrosis is an important predictor of liver-related morbidity and premature mortality. Vibration-controlled transient elastography (VCTE) is a validated non-invasive test with NPV >90% for detection of advanced fibrosis/cirrhosis but largely confined to specialist centres.

Aims/Background

To assess the feasibility of VCTE as a screening method to detect hepatic fibrosis in patients with risk factors for NAFLD in a community healthcare setting.

Method

206 patients (112 female-94 male) with risk factors for NAFLD were identified via dispensing records in pharmacies and invited to register. VCTE assessments were performed in 4 pharmacies between June-July 2021 and results sent to patients’ GPs. Patients with liver stiffness measurements (LSM) >8.2 kPa were referred to a specialist Hepatology clinic.

Results

The median age was 63 years (range 27-84). 88% of patients had T2DM and 53% had BMI ≥30. The median CAP was 291dB/m (range 160-400) and 45% of patients had CAP ≥300dB/m. The median LSM was 5.8kPa, and 31% patients had LSM ≥7.1kPa. 12% had LSM ≥9.7kPa, 6.7% had LSM ≥12.5kPa. Only 19% of patients had both a normal CAP and LSM.

Conclusions

This is the first study to assess VCTE screening for hepatic fibrosis beyond traditional healthcare settings, and demonstrates that community-based risk-stratified screening leads to earlier identification of patients with liver fibrosis. Community pharmacy is an accessible healthcare setting in which access to non-invasive assessments of hepatic fibrosis outside of the hospital setting could be offered with potential cost savings to the healthcare system.