PTH-105 hospital admission in patients with advanced chronic liver disease due to non-alcoholic fatty liver disease

Abstract

Introduction Individuals with non-alcoholic fatty liver disease (NAFLD) often have multiple medical comorbidities. The development of advanced chronic liver disease is considered a defining point in the natural history of NAFLD. The aims of this study were to pilot the use of electronic health record (EHR) follow-up of patients with NAFLD and to assess the frequency of clinical events due to both complications of liver disease and also non-liver related causes. Methods Transient elastography data was collected from St James’s University Hospital in Leeds between 2012–2017 Patients were defined as having advanced chronic liver disease based on liver stiffness measurement (LSM) >10 kPa and were analysed in two strata:≥10–15 kPa, and >15 kPa. Hospital admissions and mortality were recorded from data submitted to NHSDigital, and sub-divided into liver-related and non-liver related causes. Results The study included 486 patients: 303 (62%) male, mean age 56 years. Median follow-up interval was 24 months. Data regarding admissions is summarised in table 1. Four patients (all with LSM >20 kPa) were admitted on eight occasions with decompensation as a primary diagnosis code (5 admissions with hepatic encephalopathy, 2 variceal bleeding and 1 ascites). Four patients had primary diagnosis codes for hepatocellular carcinoma. Overall, liver-related events accounted for a minority of admissions. Considering inpatient admissions, only 1 in 5 admissions were for complications of liver disease, even amongst those individuals with LSM >15 kPa (table 1). The most common causes of non-liver related admission according to ICD-10 code were gastrointestinal (14%), cardiovascular (11%), musculoskeletal (10%) and respiratory (9%). Overall 17/486 individuals (3.5%) had died (5 patients≥10–15 kPa; 12 patients>15 kPa). Liver disease was listed as a contributing factor in a minority of cases (5/17, 29%). Conclusions EHR can be used to accurately define outcomes in patients with advanced chronic liver disease due to NAFLD. The finding that liver related morbidity and mortality accounts for only 1 in 5 clinical events for patients with NAFLD and advanced chronic liver disease will significantly reduce the effectiveness of novel therapeutics in development for this patient group.