FRI661 Assessing The Current State Of Screening And Managementof Non-alcoholic Fatty Liver Disease In An Academic Endocrinology Clinic

Abstract

Abstract Disclosure: K.M. Myers: None. C.D. Hendrickson: None. Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease and the second most common cause of liver failure leading to transplantation. NAFLD is strongly associated with factors of metabolic syndrome including diabetes mellitus (DM), with which it shares a strong bi-directional relationship. Up to 70% of patients with DM also have NAFLD, and DM is a risk factor for higher rates of NAFLD progression leading to steatohepatitis, fibrosis and cirrhosis. In September 2021, the American Gastroenterological Association published recommendations including endocrinology in the screening and management of NAFLD patients. Screening for NAFLD involves computing a FIB-4 score to risk-stratify patients into low, intermediate or high risk of having liver fibrosis. The FIB-4 score is calculated using patient age, AST, ALT and platelet count. Further management is determined by the level of risk identified, with some indeterminate-risk and all high-risk patients needing referral to hepatology clinic. Methods: Deidentified patient data was abstracted from an electronic health record registry associated with a large academic medical center. Patient qualifiers included: age over 18 years, diagnosis of type 2 DM, a prior visit within 5 years at one of two endocrinology clinic locations and having a primary care physician associated with the system. Of these patients, lab data was obtained for AST, ALT and platelet count. Additionally, the presence or absence of a prior hepatology clinic encounter was assessed. Two endocrinology clinics were analyzed, including one clinic at the main hospital campus and a second, smaller clinic located in an adjacent county. Results: Within the larger clinic, 16,398 patients met the above criteria; however, only 1797 (11.0%) had all lab components evaluated within 5 years to calculate a FIB-4 score, largely due to only 11.3% of total patients having platelet count data available. Of patients with a FIB-4 score, 342 had a score over 2.67, indicating high-risk for liver fibrosis. Of these 342 patients, 181 (53.0%) had an associated hepatology visit. Within the smaller clinic, 3844 patients met the above criteria; however, only 1055 (274%) had all lab components evaluated within 5 years to calculate a FIB-4 score, again largely due to only 30.0% of total patients having platelet count data available. Of the patients with a FIB-4 score, 148 had a score ≥ 2.67, indicating high-risk for liver fibrosis. Of these 148 patients, 47 (31.8%) had an associated encounter with hepatology. Conclusion: This study highlights a need for improved screening and risk-stratification of diabetic patients for NAFLD, including the increased awareness of screening with appropriate lab evaluation and subsequent referral to hepatology when appropriate. Presentation: Friday, June 16, 2023