AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Liver Injury and Cancer Program, Centenary Institute, Sydney, New South Wales, Australia.
Hepatol Commun. 2024 Jun 27;8(7). doi: 10.1097/HC9.0000000000000482. eCollection 2024 Jul 1.
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.
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.
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).
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.
识别未确诊的慢性肝病（ACLD）患者是一个公共卫生挑战。患有晚期纤维化或代偿性肝硬化的患者比失代偿性疾病患者的预后要好得多，并且可能有资格接受干预措施以防止疾病进展。
开发了一种基于云的软件解决方案（“Liver Toolkit”），以访问初级保健实践软件来识别有 ACLD 风险的患者。提取临床病史和实验室结果以计算天冬氨酸氨基转移酶与血小板比值指数和纤维化 4 评分。召回有确诊肝硬化的患者进行评估，包括通过瞬态弹性成像进行肝硬度测量（LSM）。
评估了九个普通诊所超过 32,000 名成年人的现有实验室结果，以确定 703 名患有 ACLD 的高危患者（队列的 2.2%）。成功召回了 179 名患者（26%），其中 23/179（13%）被确定患有 ACLD（LSM≥10.0kPa）（10%处于不确定风险[LSM 8.0-9.9kPa]，77%低纤维化风险[LSM<8.0kPa]）。在大多数情况下，肝病的诊断是新的，最常见的病因是代谢功能障碍相关脂肪性肝病（n=20，83%）。天冬氨酸氨基转移酶与血小板比值指数≥1.0 和纤维化 4≥3.25 分别对 ACLD 的阳性预测值为 19%和 24%。未参加召回的患者的疾病严重程度标记物更高，天冬氨酸氨基转移酶与血小板比值指数评分中位数更高（0.57 与 0.46，p=0.041）。
该新型信息技术系统使用现有实验室结果成功筛选了大量初级保健队列，以识别患有 ACLD 风险增加的患者。召回的患者中有 1/5 以上被发现患有需要专科随访的肝脏疾病。
