Abstract
SIX-YEAR FOLLOW-UP OF MANAGING PREDOMINANTLY HISPANIC PATIENTS WITH SIGNIFICANT STEATOSIS AT A PRIMARY CARE CLINIC
Background:
The prevalence of obesity and metabolic syndrome is on the rise in the US particularly in Hispanic patients. Individuals with Nonalcoholic Fatty Liver Disease (NAFLD) are prone to progress to Nonalcoholic Steatohepatitis (NASH), which could lead to cirrhosis and liver cancer. Early identification of individuals at risk for developing NASH is critical. In 2017 we initiated and reported on a screening program for fatty liver and liver fibrosis using FibroScan® in a primary care practice (PCP) with predominantly Hispanic patients in Southern California “South Bay fatty liver cohort”. This is a 6-year report on the disposition of the patients and follow-up in the primary care setting in contrast to those referred to a Hepatology practice.
Methods: Between March, 2017 and June, 2017 958 adults (18 years and older) attending a primary care clinic, who had no known history of liver disease agreed to be screened and had an evaluable Fibroscan®. Pts were followed and managed per standard of care in the primary care setting including annual check-ups, FibroScan® assessments and referral to specialists if needed.
Results: Of the 958 pts, 622 pts (64.9%) changed their health insurance carrier and had a change in their Primary Care practice during the COVID-19 pandemic, 6 pts (0.6%) were deceased, 109 pts (16.6%) were not able to be reached. The subjects of this analysis are 221 pts who returned for a 6-year follow-up. 68.2% were females; mean age was 56.0 ±15.4 years and 86.4% Hispanic. ALT, AST, and Albumin were within normal range at baseline and 6-year follow-up. APRI was not applicable in this population and all had a score <=0.1 at baseline and follow-up. Similarly, all had a Fib-4 Index <1 at baseline and follow-up. Refer to table 1 for the 6-year change in BMI, FibroScan®, Hemoglobin A1C, and metabolic syndrome.
Conclusion:
In a pre-dominantly Hispanic community patient population with no known history of fatty liver disease attending a primary care clinic at baseline, 23% of patients continued to be followed up regularly. Over 6 years with annual follow-up visits, there was 1) a slight change in the fat infiltration and minimal change in liver stiffness measure by FibroScan®, 2) significant progression in the metabolic syndrome presentation and risk factors, and 3) significant changes in health insurance status and routine follow-up. This underscores the importance of implementing incentive programs for PCP based on patients outcomes in respect to the management of patients with NAFLD. In addition, these findings re-emphasize the need for educational programs to PCP on the nonalcoholic fatty liver disease spectrum, its consequences as well as the importance of close follow-up of patients at risk for metabolic syndrome and when to refer to liver specialists.