Primary care-based triage of steatotic liver diseases.

Hinkson, A.P.; Wong, J.A.; Canter, T.; Ong, E.; Gold, M.; Monfared, N.; Rowe, I.A.; Glynn, P.; Jones, R.L.; Parker, R.

Primary care-based triage of steatotic liver diseases.

All Authors

Hinkson, A.P.

Wong, J.A.

Canter, T.

Ong, E.

Gold, M.

Monfared, N.

Rowe, I.A.

Glynn, P.

Jones, R.L.

Parker, R.

LTHT Author

Hinkson, Alexander
Wong, Jo Ann
Canter, Timothy
Ong, Elaine
Rowe, Ian
Jones, Rebecca
Parker, Richard
Gold, Matthew
Monfared, Niloufar

LTHT Department

Abdominal Medicine & Surgery
Liver Unit
Doctor's Rotation
Doctors' Rotation
Hepatology

Publication Date

2025

Item Type

Article In Press

Abstract

Objective Non-invasive staging of fibrosis in steatotic liver disease (SLD) is an important step in identifying individuals most at risk. We developed and evaluated a pathway using the enhanced liver fibrosis (ELF) test to guide referrals to community hepatology (C-HEP) clinical review with a specialist hepatologist. Method This retrospective longitudinal cohort study compared the C-HEP pathway with the previously established referral pathway for suspected SLD. Individuals with ELF above a certain threshold went on to have liver stiffness measurement (LSM). LSM >=12.5kPa was considered to indicate advanced fibrosis and >=20kPa cirrhosis. In uncertain cases, patients were referred for liver biopsy and for these, the histological stage was used. Results In total, 882 patients were referred via the C-HEP pathway in 18 months and 571 met the threshold for clinical review. Of these, 421 (73.7%%) were deemed low risk, 77 (13.4%) had advanced fibrosis and 39 (6.8%) had cirrhosis. The cost per patient assessed on this pathway was 173.23 and the cost per case of advanced disease found was 1984.22. By comparison, in the standard referral pathway, 23.1% of patients were found to have advanced fibrosis and 15.9% had cirrhosis. The cost per patient seen was 457.36 and 1560.40 per case of advanced disease. Conclusion The Leeds Community Hepatology Pathway is a simple-to-use pathway to guide referral of patients with suspected SLD. Use of the ELF test with a threshold of 9.5 can triage appropriate referrals in a cost-effective manner. Further data regarding referral pathways will help to guide recommendations for effective management of the large number of individuals with SLD.