Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Am J Med Sci. 2024 Nov;368(5):455-461. doi: 10.1016/j.amjms.2024.07.028. Epub 2024 Jul 27.
As metabolic dysfunction-associated steatotic liver disease (MASLD) management extends into primary care, little is known about patterns of specialty referral for affected patients. We determined the proportion of primary care patients with MASLD that received a gastroenterology (GI) consultation and compared advanced fibrosis risk between patients with and without a referral.
This retrospective study of electronic health record data from a primary care clinic included patients with MASLD, no competing chronic liver disease diagnoses, and no history of cirrhosis. Referral to GI for evaluation and management (E/M) any time after MASLD ascertainment was the outcome. Fibrosis-4 Index (FIB-4) scores were calculated, categorized by advanced fibrosis risk, and compared by receipt of a GI E/M referral. Logistic regression models were developed to determine the association of FIB-4 risk with receipt of a GI referral.
The cohort included 652 patients of which 12% had FIB-4 scores (≥2.67) at high-risk for advanced fibrosis. Overall, 31% of cohort patients received a GI referral for E/M. There was no difference in the proportion of patients with high (12% vs. 12%, p=0.952) risk FIB-4 scores by receipt of a GI E/M referral. In adjusted logistic regression models, high-risk FIB-4 scores (OR 1.01; 95% CI 0.59 - 1.71) were not associated with receipt of a referral.
Only 30% of patients in this primary care MASLD cohort received a GI E/M referral during the study period, and those patients with a referral did not differ by FIB-4 advanced fibrosis risk.
随着代谢功能相关脂肪性肝病 (MASLD) 管理扩展到基层医疗，人们对受影响患者的专科转诊模式知之甚少。我们确定了接受胃肠病学 (GI) 咨询的 MASLD 初级保健患者的比例，并比较了有和无转诊患者的晚期纤维化风险。
这项回顾性研究使用了来自初级保健诊所的电子健康记录数据，纳入了 MASLD、无竞争慢性肝病诊断且无肝硬化病史的患者。任何时候因 MASLD 确定后转诊到 GI 进行评估和管理 (E/M) 是研究的结局。计算纤维化-4 指数 (FIB-4) 评分，根据晚期纤维化风险进行分类，并比较是否接受 GI E/M 转诊。采用逻辑回归模型确定 FIB-4 风险与接受 GI 转诊之间的关联。
该队列包括 652 名患者，其中 12%的患者 FIB-4 评分（≥2.67）处于晚期纤维化高风险。总体而言，31%的患者因 E/M 转诊接受了 GI 咨询。根据是否接受 GI E/M 转诊，高风险 FIB-4 评分患者（12%与 12%，p=0.952）的比例无差异。在调整后的逻辑回归模型中，高风险 FIB-4 评分（比值比 1.01；95%置信区间 0.59 - 1.71）与转诊无关。
在本初级保健 MASLD 队列中，只有 30%的患者在研究期间接受了 GI E/M 转诊，且接受转诊的患者与 FIB-4 晚期纤维化风险无差异。
