PTH-085 Using ELF tests in primary and secondary care to identify patients with advance fibrosis

Introduction

In 2016 NICE NAFLD guidelines recommended Enhance Liver Fibrosis (ELF) as a validated test to assess advanced liver fibrosis. This study aims ELF tests were performed, 166 from by GP practices and 175 by UHS hepatology service. 89 were from other organisations. to assess the relationship with standard investigations used in a hepatology clinic for NAFLD patients (including transient elastography) and the newly commissioned ELF test in a real world setting.

Methods

The study looked at all new patients diagnosed with NAFLD via the hepatology outpatient clinic at University Hospital Southampton between November 2016 and May 2017. Each patient had their demographics (age, gender, weight) and comorbidities (diabetes, hypertension, dyslipidaemia) assessed. Transient elastography, USS and ELF Result (when performed) were reviewed. The ELF was categorised as no/mild fibrosis if <7.5, moderate fibrosis if ≥7.5 and≤10.5, advanced fibrosis if ≥10.51. The ELF tests requested over the same period were analysed review the source of the request.

Results

175 people were diagnosed with NAFLD through hepatology clinic. All patients had transient elastography performed. The mean LSM Result was 14.6 (range 3.3–75), with a mean CAP score of 313.6 (range 100–400). Of 175 new diagnoses, 101 patients were male (mean weight 99 kg, median age 52 years) and 74 were female (87.1 kg and 57 years). 69 patients had type 2 diabetes mellitus, 74 had hypertension and 66 had dyslipidaemia. 30 patients had all 3 (16 were female with a mean weight 96.5 kg and mean LSM 18.5 kPa and 14 were male, 100.7 kg and 19.3 kPa). With transient elastography, 59 patients had LSM <6 kPa, 68 were 6.1–12 kPa, 23 were 12.1–20 kPa and 25>20.1 kPa. This suggested 48 (27%) patients had advanced fibrosis or cirrhosis. The remaining 127 (73%) patients did not require hepatology review. 430The GP cohort had 18 (11%) patients with an ELF test ≥10.5 requiring hepatology review. 36 (21%) patients seen in the hepatology clinic had an ELF >10.51, the remaining 139 (79%) patient did not require a hepatology review.

Conclusions

This study looked at the cohort of new diagnoses of NAFLD in a teaching hospital using standard tests and ELF score. Currently, access to transient elastography is secondary care based. The preliminary data in this study shows that the ELF test is a good first line investigation for GPs suspecting NAFLD in a patient with type 2 diabetes and obesity or incidental finding of fatty liver. It promotes the need to look beyond the routine liver panel test and identify the aetiology of liver disease and assess extent of liver fibrosis; in turn, to generate appropriate secondary care referrals and incorporate efficiency. Further assessment of the use of ELF in this setting continues