1066 Effectiveness of a Nurse-Led Fibroscan Service Towards Enhanced Care in Liver Disease

Abstract

INTRODUCTION: Fibroscan as a convenient, non invasive tool for classification of Liver Stiffness (KPA) and fat component (CAP) has gained popularity in the hospital as well as community health services .With burden of liver disease significantly affecting the NHS in terms of finances as well as mortality, an accurate measure of the liver parenchyma assists in delivery of safe enhanced care.We present our nurse led fibroscan service in comparison to conventional modalities in the management of liver disease. METHODS: 273 patients were referred to the Nurse led Fibroscan service from July 2017-18.The Fibroscan readings were then compared to the USS, biochemistry and liver biopsy results. British Society of Gastroenterology(BSG) guidelines were then used to manage these subjects. RESULTS: Out of 273 patients referred 30 were excluded due to difficult procedures. Out of 243 screened, 52.68% were female.An average age of 53.9 years was seen (Median 55,IQR 19).The Fibroscan results were classified based on KPA and CAP for different etiology.Mean ALT of 49.22 was seen. Fibroscan results showed , Normal 9.87% ,Fatty Liver = 50.2%,Fibrosis = 22.2%and Cirrhosis 17.69% and compared to USS. Of the 48 subjects with Normal USS, 22 showed fatty liver, 9 had fibrosis and 2 had cirrhosis on fibroscan showing a 68.75% variance in diagnosis indicating a worsening stage of liver disease. Of the 123 that had fatty liver on USS,81 had the same diagnosis on fibroscan too.There was variance in 34.14% with 3 showing a better diagnosis having Normal fibroscan and 23 and 16 subjects showing fibrosis and cirrhosis respectively, indicating a worsening diagnosis. As Per BSG guidelines, fatty liver disease and ALT of below 50 can be discharged back to the care fo GP. 51.2% of these patients were similarly discharged to the GP. 70 subjects had Cirrhosis on USS 45 had a better diagnosis indicating the variance to be 50%. The total variance in diagnosis was noted in 122 (50.2%) from USS to fibroscan, with 41% (n = 50)having a better stage and 72 (59%) showing worse stage of disease. 44 of these subjects underwent liver biopsies which correlated to the above findings in similar percentage. CONCLUSION: Nurse led fibroscan service shows effective monetary benefit in good enhanced care of liver disease. It gives a more accurate diagnosis as compared to USS and also helps in avoiding the invasive liver biopsy in majority of the cases. Utilised in a correct manner it can help in appropriate care of the liver disease patients.