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Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care
Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver‐related morbidity. Noninvasive methods such as vibration‐controlled transient elastography (VCTE) and Fibrosis‐4 index (FIB‐4) have been recommended to iden...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771169/ https://www.ncbi.nlm.nih.gov/pubmed/31592044 http://dx.doi.org/10.1002/hep4.1411 |
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author | Davyduke, Tracy Tandon, Puneeta Al‐Karaghouli, Mustafa Abraldes, Juan G. Ma, Mang M. |
author_facet | Davyduke, Tracy Tandon, Puneeta Al‐Karaghouli, Mustafa Abraldes, Juan G. Ma, Mang M. |
author_sort | Davyduke, Tracy |
collection | PubMed |
description | Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver‐related morbidity. Noninvasive methods such as vibration‐controlled transient elastography (VCTE) and Fibrosis‐4 index (FIB‐4) have been recommended to identify patients for further assessment. The aim of this study was to assess the potential impact of implementing a “FIB‐4 First” strategy to triage patients entering a NAFLD assessment pathway. The pathway for patients with suspected NAFLD was piloted at a tertiary liver center. Referral criteria were 16‐65 years old, elevated alanine aminotransferase and/or steatosis on imaging, and absence of a previous liver diagnosis. A registered nurse risk‐stratified all patients based on VCTE and FIB‐4 was calculated. Potential alternative diagnoses were excluded with bloodwork. A total of 565 patients underwent risk stratification with VCTE with a 97% success rate. Ten percent had VCTE of at least 8 kPa; 560 patients had FIB‐4 available for analysis and 87% had values less than 1.3. Of those with a FIB‐4 of at least 1.3, 69% had a VCTE less than 8 kPa. Further modeling showed that the presence of diabetes, age, and body mass index had only a moderate impact on the association between FIB‐4 and elastography values if using a FIB‐4 threshold of 1.3. Conclusion: A FIB‐4 threshold of 1.3 was acceptable for excluding the presence of advanced fibrosis (assessed by VCTE). A staged risk‐stratification model using FIB‐4 and VCTE could save up to 87% of further assessments. This model could improve accessibility by moving the initial fibrosis evaluation to the medical home and helping to prioritize patients for further specialized care. |
format | Online Article Text |
id | pubmed-6771169 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-67711692019-10-07 Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care Davyduke, Tracy Tandon, Puneeta Al‐Karaghouli, Mustafa Abraldes, Juan G. Ma, Mang M. Hepatol Commun Original Articles Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver‐related morbidity. Noninvasive methods such as vibration‐controlled transient elastography (VCTE) and Fibrosis‐4 index (FIB‐4) have been recommended to identify patients for further assessment. The aim of this study was to assess the potential impact of implementing a “FIB‐4 First” strategy to triage patients entering a NAFLD assessment pathway. The pathway for patients with suspected NAFLD was piloted at a tertiary liver center. Referral criteria were 16‐65 years old, elevated alanine aminotransferase and/or steatosis on imaging, and absence of a previous liver diagnosis. A registered nurse risk‐stratified all patients based on VCTE and FIB‐4 was calculated. Potential alternative diagnoses were excluded with bloodwork. A total of 565 patients underwent risk stratification with VCTE with a 97% success rate. Ten percent had VCTE of at least 8 kPa; 560 patients had FIB‐4 available for analysis and 87% had values less than 1.3. Of those with a FIB‐4 of at least 1.3, 69% had a VCTE less than 8 kPa. Further modeling showed that the presence of diabetes, age, and body mass index had only a moderate impact on the association between FIB‐4 and elastography values if using a FIB‐4 threshold of 1.3. Conclusion: A FIB‐4 threshold of 1.3 was acceptable for excluding the presence of advanced fibrosis (assessed by VCTE). A staged risk‐stratification model using FIB‐4 and VCTE could save up to 87% of further assessments. This model could improve accessibility by moving the initial fibrosis evaluation to the medical home and helping to prioritize patients for further specialized care. John Wiley and Sons Inc. 2019-07-29 /pmc/articles/PMC6771169/ /pubmed/31592044 http://dx.doi.org/10.1002/hep4.1411 Text en © 2019 The Authors. Hepatology Communications published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Davyduke, Tracy Tandon, Puneeta Al‐Karaghouli, Mustafa Abraldes, Juan G. Ma, Mang M. Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title | Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title_full | Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title_fullStr | Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title_full_unstemmed | Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title_short | Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care |
title_sort | impact of implementing a “fib‐4 first” strategy on a pathway for patients with nafld referred from primary care |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771169/ https://www.ncbi.nlm.nih.gov/pubmed/31592044 http://dx.doi.org/10.1002/hep4.1411 |
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