Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit.

IF 5.6 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI:10.1097/HC9.0000000000000482
David S Prince, Shakira Hoque, Christy Kim, Salim Maher, Jane Miller, Phoebe Chomley, Janice Pritchard-Jones, Sally Spruce, Nathan McGarry, David Baker, Penelope Elix, Ken Liu, Simone I Strasser, Brendan Goodger, Amany Zekry, Geoffrey W McCaughan
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引用次数: 0

Abstract

Background: Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression.

Methods: A cloud-based software solution ("the Liver Toolkit") was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded.

Results: Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0-9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction-associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041).

Conclusions: This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.

利用创新的信息技术解决方案,在全科医生中筛查晚期慢性肝病患者:肝脏工具包。
背景:识别未确诊的晚期慢性肝病(ACLD)患者是一项公共卫生挑战。晚期肝纤维化或代偿期肝硬化患者的预后比失代偿期患者要好得多,可能有资格接受干预以防止疾病进展:方法:开发了一个基于云的软件解决方案("肝脏工具包"),用于访问初级保健实践软件,以识别有患 ACLD 风险的患者。提取临床病史和实验室结果,计算天门冬氨酸氨基转移酶与血小板比率指数和纤维化4级评分。对确定的患者进行召回评估,包括通过瞬态弹性成像进行肝脏硬度测量(LSM)。已确诊为肝硬化的患者被排除在外:对九家全科诊所 32,000 多名成人的现有实验室结果进行了评估,确定了 703 名患 ACLD 风险增加的患者(占队列的 2.2%)。179名患者(26%)被成功召回,其中23/179(13%)被确定为患有ACLD(LSM≥10.0 kPa)(10%为不确定风险[LSM 8.0-9.9 kPa],77%为纤维化低风险[LSM 结论:这一新型信息技术系统成功筛查了703名ACLD高风险患者(2.2%):这种新颖的信息技术系统利用现有的实验室结果,成功地筛查了一大批初级保健人群,从而识别出 ACLD 风险增高的患者。在被召回的患者中,每5人中就有1人以上患有肝病,需要专科随访。
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来源期刊
Hepatology Communications
Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
8.00
自引率
2.00%
发文量
248
审稿时长
8 weeks
期刊介绍: Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction. ​
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