Detección de enfermedad hepática avanzada incorporando el uso de la elastografía de transición en atención primaria

Abstract

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 ≥ 8 kPa were referred to HC.

Results

326 patients were studied. 71% were not referred to HC, due to liver stiffness < 8 kPa. 83 of the 95 derivations did TE in HC. 45 (54%) had TE ≥ 8, and 25 (30%) ≥ 12. The proportion of patients with stiffness ≥ 8 kPa was 13,8% (45/326) and ≥ 12 kPa, 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.