Assessing factors related to clinically advanced fibrosis in patients with Nonalcoholic Fatty Liver Disease or nonalcoholic steatohepatitis

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Yu, Anthony William

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Background: Nonalcoholic Fatty Livery Disease (NAFLD) affects a large population in the US, with significant morbidity and mortality risks associated with advanced fibrosis. The 2023 American Association for the Study of Liver Diseases NAFLD Guidelines recommend using FIB-4, a simple and cost-effective non-invasive test, as a first-line assessment for patients with hepatic steatosis or suspected NAFLD. Early identification of at-risk patients using this tool can inform targeted management decisions and prevent complications. Objective: To describe the clinical profile of NAFLD or nonalcoholic steatohepatitis (NASH) patients in a Texas integrated delivery network and elucidate the local relationship between patient factors and risk of advanced fibrosis. Methods: This observational, retrospective, cross-sectional study utilized existing data from the electronic health record at a large integrated delivery network in Texas. Data were collected during the study period from January 1, 2019, to March 1, 2023. Patient characteristics, comorbidities, labs, and medication orders were collected from the most recent encounter in which a FIB-4 score could be calculated. Chi square tests and ANOVA tests were conducted to evaluate differences among the three fibrosis risk categories. Ordered logistic regression was utilized to assess associations between select variables and the likelihood of having an intermediate or high risk of advanced fibrosis. Results: A total of 56,253 patients were included in the study. 34,839 (61.9%) were Low Risk, 15,578 (27.7%) were Intermediate Risk, and 5,836 (10.4%) were High Risk of advanced fibrosis. Results showed that up to 70.4% of patients were obese within a risk group. Only 49.5% of patients in the High Risk group had at least one gastroenterologist or hepatologist visit. Males, Medicare patients, former smokers, and those with hypertension, type 2 diabetes, and an eGFR <60 had higher odds of being in the Intermediate or High Risk groups. Conclusion: This study highlights the need for early screening, proactive management of metabolic risk factors, and improved care for patients with NAFLD/NASH. The findings indicate a notable prevalence of obesity in the study population, a need for specialist referral for those with high risk of advanced fibrosis, and the importance of routine labs to evaluate metabolic factors.


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