Mar Noguerol Álvarez, Ma Paz Valer López Fando, Carolina Torrijos Bravo, Ma Carmen Gómez Ortiz, Belén Piqueras Alcohol, Antonio Guardiola Arévalo, Gema De la Poza Gómez, Zahara Pascual García, Sandra Rey Rodríguez, Raquel Iglesias Sigüenza, Esther Ledesma Estévez, Susana Parra Román, María Gómez Suárez, Angela Pérez San Juan, Miriam Ruiz Romero, Laura Martínez Vega, Beatriz López Uriarte, Francisco Góngora Maldonado, Blanca Martín Porras, Pilar Serrano Gismero, Elvira Rubio Benito, Gloria Viñas Fernández, Ma José Rojas Giraldo, Ana Ma Hernández Sánchez, María Alonso Ovies, Gema María Saiz Ladera, Nuria Martín Peña, Jesús Fernández Horcajuelo, Victoria Llinares Gómez, José Francisco Sánchez Mateos, Elena Polentinos Castro, Ricardo Rodríguez Barrientos, Manuel Carbajo Ariza, Greta Amat Baeza, Fernando Bermejo San José
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To know the agreement between FIB-4 and transitional elastography (TE), interobserver agreement between PC and hospital care (HC) in TE, and associated risk Factors (RF).</p><p><strong>Methods: </strong>Observational, descriptive, cross-sectional study in ≥16 years of age with RF for chronic liver disease. Sex and age, RF (alteration of liver tests [LT], metabolic syndrome, diabetes, obesity, alcohol consumption, hepatic steatosis), and FIB-4, controlled attenuation parameter and TE in PC and in HC, were collected. According to a consensus algorithm, vibration-controlled TE was performed in PC in patients with FIB-4≥1,3, and those with measurement ≥8kPa were referred to HC.</p><p><strong>Results: </strong>326 patients were studied. 71% were not referred to HC, due to liver stiffness <8kPa. 83 of the 95 derivations did TE in HC. 45 (54%) had TE ≥8, and 25 (30%) ≥12. The proportion of patients with stiffness ≥8kPa was 13,8% (45/326) and ≥12kPa, 7,6% (25/326). 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引用次数: 0
摘要
目的描述基层医疗机构（PC）高危人群中肝脏纤维化患者的比例。了解 FIB-4 和过渡弹性成像（TE）之间的一致性、PC 和医院护理（HC）在过渡弹性成像中的观察者间一致性以及相关风险因素（RF）：观察性、描述性、横断面研究，对象为年龄≥16 岁的慢性肝病 RF 患者。研究收集了性别和年龄、RF（肝脏检查（LT）改变、代谢综合征、糖尿病、肥胖、饮酒、肝脏脂肪变性）、FIB-4、PC 和 HC 的受控衰减参数和 TE。根据共识算法，FIB-4≥1,3的患者在PC中进行振动控制TE，测量值≥8 kPa的患者转至HC：研究了 326 名患者。71%的患者因肝僵化而未被转至肝脏疾病中心：LT改变和肥胖：该研究支持将血清指数和 TE 作为 PC 高危人群肝纤维化筛查的先后顺序，从而降低转诊至 AH 的患者比例，并更好地对高危患者进行分层。
Screening for advanced liver disease incorporating the use of transitional elastography in primary care.
Objectives: To describe the proportion of patients with liver fibrosis in at-risk populations in primary care (PC). To know the agreement between FIB-4 and transitional elastography (TE), interobserver agreement between PC and hospital care (HC) in TE, and associated risk Factors (RF).
Methods: Observational, descriptive, cross-sectional study in ≥16 years of age with RF for chronic liver disease. Sex and age, RF (alteration of liver tests [LT], metabolic syndrome, diabetes, obesity, alcohol consumption, hepatic steatosis), and FIB-4, controlled attenuation parameter and TE in PC and in HC, were collected. According to a consensus algorithm, vibration-controlled TE was performed in PC in patients with FIB-4≥1,3, and those with measurement ≥8kPa were referred to HC.
Results: 326 patients were studied. 71% were not referred to HC, due to liver stiffness <8kPa. 83 of the 95 derivations did TE in HC. 45 (54%) had TE ≥8, and 25 (30%) ≥12. The proportion of patients with stiffness ≥8kPa was 13,8% (45/326) and ≥12kPa, 7,6% (25/326). The predictive values of the FIB-4 were low. The interobserver correlation coefficient between TE in PC and HC was 0,433. Variables associated with TE ≥8 in PC: LT alteration, diabetes and steatosis. With TE ≥12: LT alteration, diabetes and obesity.
Predictor variables: LT alteration and obesity.
Conclusions: The study supports the sequential performance of serum indices and TE as a screening for fibrosis in the at-risk population in PC, which allows a reduction in the percentage of patients referred to AH, and a better stratification of risk patients.
期刊介绍：
Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.
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