Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1598
Peer-review started: March 7, 2022
First decision: June 8, 2022
Revised: June 30, 2022
Accepted: August 10, 2022
Article in press: August 10, 2022
Published online: August 27, 2022
Nonalcoholic fatty liver disease (NAFLD) presents a significant public health crisis to primary care physicians and endocrinologists. This growing need necessitates a simple and efficient algorithm that can streamline the process of subspecialty referral to hepatology.
More than half of all patients with NAFLD are at low risk for advanced fibrosis. Though there are no Food and Drug Administration -approved agents for nonalcoholic steatohepatitis (NASH) presently, the efficient identification of patients with NASH with advanced fibrosis will be paramount in the care of these patients.
This study aims to create and enact a diagnostic algorithm for all patients with suspected NAFLD to identify the patients at high risk for advanced fibrosis.
Patients with suspected NAFLD were identified in the NHANES database who had historical FibroScan data. FIB4 and FAST scores were calculated for these patients. Those with FIB4 > 1.3 and/or FAST score > 0.67 were deemed high risk for advanced fibrosis.
Of the 3669 patients meeting the inclusion and exclusion criteria, only 75 patients had both an elevated FIB4 and an elevated FAST score which represents roughly 2.0% of the overall population. Among the 737 patients with type 2 diabetes mellitus, 42 patients (5.1%) were found to have both elevated FIB4 and FAST scores.
Given an overwhelming number of patients are referred to hepatology who are most likely at low risk for advanced fibrosis, the utilization of this algorithm by referring providers would help to streamline the process for referrals and eventually more seamlessly identify patients at risk for advanced fibrosis who may need therapy for NASH.
As novel therapeutic agents are currently being studied in patients with NASH with advanced fibrosis, the creation and implementation of a diagnostic algorithm to efficiently identify patients needing therapy becomes increasingly important. Given the wide range of noninvasive tests, this algorithmic approach using two popular tests helps to capture patients at risk for advanced fibrosis while reassuring low-risk patients.