Identifying advanced liver disease in asymptomatic patients in primary care: an evaluation of patient outcomes 24 months after implementing a primary care liver pathway and community liver service

Abstract

Background and aims
In 2019, Southampton Clinical Commissioning Group implemented a liver guidance pathway and community liver service to help early detection and reduce the number of deaths from liver disease. The liver guidance pathway
supports primary care clinicians identify patients at risk of liver disease to access early intervention before developing to advanced liver disease. The community liver service provides vibration controlled transient elastography (VCTE) assessment to patients who, after following the liver guidance pathway, have been identified as having severe liver fibrosis. This study aims to evaluate the patient outcomes 24 months after implementing the liver pathway and VCTE
service.
Method
All patients referred to the Southampton community liver service between January 2019 and December 2020. Demographics recorded included: Age, sex, body mass index (BMI), alcohol consumption (high or low), VCTE reading (kPa), diagnosis (alcohol related liver disease, non-alcoholic fatty liver disease or both) and patient outcomes (stay in primary care or refer to secondary care for clinical management).
Results
527/632 patients referred to the community liver service received a VCTE assessment.16.6% (n = 105) did not attend their appointment and for 0.9% (n = 5), no valid VCTE reading was obtained. The median (IQR) age of patients was 58 (46–65) years, 58.6% were male; median (IQR) BMI was 30.5 (27.1–35.1) kg/m² and alcohol consumption in 23.9% (n = 126) was graded as high (defined as drinking more than the UK recommended alcohol guidelines). Mean (SD) VCTE was 9.5 (9.2) kPa, of whom 8% (n = 42) had a reading of >20.0 kPa. 77.4% (n = 408) were diagnosed with non-alcoholic fatty liver disease (NAFLD); 15.7% (n = 83) with alcohol related liver disease (ARLD) and 6.8% (n = 36) with both NAFLD and ARLD. 27.9% (n = 147) of patients were found to have a liver fibrosis stage of F3/F4 (9.7 kPa–13.5 kPa/>13.6 kPa) and were referred to secondary care. 71.0% (n =374) had a liver fibrosis stage of F0-F2 (between 3.0 kPa and 9.6 kPa)
and were referred back to primary care for repeat VCTE assessment in 3 years time.

More information

Identifiers

ORCID for Tina Natalie Reinson: orcid.org/0000-0002-2436-1906

ORCID for Christopher Byrne: orcid.org/0000-0001-6322-7753

Catalogue record

Export record

Altmetrics