BACKGROUND There is an urgent need to risk stratify patients with suspected nonalcoholic fatty liver disease(NAFLD)and identify those with fibrotic nonalcoholic steatohepatitis.This study aims to apply a simple diagno...BACKGROUND There is an urgent need to risk stratify patients with suspected nonalcoholic fatty liver disease(NAFLD)and identify those with fibrotic nonalcoholic steatohepatitis.This study aims to apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.AIM To apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.METHODS Adult subjects were included from the National Health and Nutrition Examination Survey database(2017-2018)if they had elevated alanine aminotransferase(ALT)and excluded if they had evidence of viral hepatitis or significant alcohol consumption.A fibrosis-4(FIB4)cutoff of 1.3 differentiated patients with low risk vs high risk disease.If patients had FIB4>1.3,a FAST score<0.35 ruled out advanced fibrosis.Patients with FAST>0.35 were referred to a specialist.The same algorithm was applied to subjects with type 2 diabetes mellitus(T2DM).RESULTS Three thousand six hundred and sixty-nine patients were identified who met all inclusion and exclusion criteria.From this cohort,911(28.6%)patients had elevated ALT of which 236(22.9%)patients had elevated FIB4 scores≥1.3.Among patients with elevated FIB4 score,75(24.4%)had elevated FAST scores,ruling in advanced fibrosis.This accounts for 2.0%of the overall study population.Applying this algorithm to 737 patients with T2DM,213(35.4%)patients had elevated ALT,85(37.9%)had elevated FIB4,and 42(46.1%)had elevated FAST scores.This accounts for 5.7%of the population with T2DM.CONCLUSION The application of this algorithm to identify at-risk NAFLD patients in need for specialty care is feasible and demonstrates that the vast majority of patients do not need subspecialty referral for NAFLD.展开更多
基金Supported by AHRQ grant,No.R01HS026937(Le P and Payne J)。
文摘BACKGROUND There is an urgent need to risk stratify patients with suspected nonalcoholic fatty liver disease(NAFLD)and identify those with fibrotic nonalcoholic steatohepatitis.This study aims to apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.AIM To apply a simple diagnostic algorithm to identify subjects with at-risk NAFLD in the general population.METHODS Adult subjects were included from the National Health and Nutrition Examination Survey database(2017-2018)if they had elevated alanine aminotransferase(ALT)and excluded if they had evidence of viral hepatitis or significant alcohol consumption.A fibrosis-4(FIB4)cutoff of 1.3 differentiated patients with low risk vs high risk disease.If patients had FIB4>1.3,a FAST score<0.35 ruled out advanced fibrosis.Patients with FAST>0.35 were referred to a specialist.The same algorithm was applied to subjects with type 2 diabetes mellitus(T2DM).RESULTS Three thousand six hundred and sixty-nine patients were identified who met all inclusion and exclusion criteria.From this cohort,911(28.6%)patients had elevated ALT of which 236(22.9%)patients had elevated FIB4 scores≥1.3.Among patients with elevated FIB4 score,75(24.4%)had elevated FAST scores,ruling in advanced fibrosis.This accounts for 2.0%of the overall study population.Applying this algorithm to 737 patients with T2DM,213(35.4%)patients had elevated ALT,85(37.9%)had elevated FIB4,and 42(46.1%)had elevated FAST scores.This accounts for 5.7%of the population with T2DM.CONCLUSION The application of this algorithm to identify at-risk NAFLD patients in need for specialty care is feasible and demonstrates that the vast majority of patients do not need subspecialty referral for NAFLD.
