Abstract
Screening strategies for hepatic fibrosis are heavily focused on patients with fatty liver on sonography in primary care centers. This study aimed to investigate the target population for screening significant hepatic fibrosis in primary care centers. This retrospective cross-sectional cohort study used data from 13 nationwide centers. A total of 5111 subjects who underwent both abdominal sonography and magnetic resonance elastography as part of their health check-up were included. Subjects with viral hepatitis and/or a history of significant alcohol consumption were excluded. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of significant and advanced hepatic fibrosis was 7.3% and 1.9%, respectively. Among the subjects with significant hepatic fibrosis, 41.3% did not have fatty liver. Hepatic fibrosis burden increased according to the number of metabolic risk abnormalities. Nearly 70% of subjects with significant hepatic fibrosis also had two or more metabolic risk abnormalities and/or diabetes. However, the prevalence of fibrosis did not differ between the groups with and without fatty liver. The presence of two or more metabolic risk abnormalities was an independent risk factor for significant hepatic fibrosis regardless of the fatty liver. Therefore, in the setting of primary care centers, screening for hepatic fibrosis would better be extended to subjects with metabolically unhealthy status beyond those with fatty liver.
Highlights
IntroductionConsidering the direct relationship between significant hepatic fibrosis and the risk of liverrelated mortality [3,4], screening strategy and defining high risk group for significant hepatic fibrosis among the average risk group are important in primary care centers
The prevalence of significant hepatic fibrosis in the general population is 5.1–9.5% [1,2].Considering the direct relationship between significant hepatic fibrosis and the risk of liverrelated mortality [3,4], screening strategy and defining high risk group for significant hepatic fibrosis among the average risk group are important in primary care centers
To date, screening strategies for significant and advanced hepatic fibrosis in the general population have focused on the presence of fatty liver
Summary
Considering the direct relationship between significant hepatic fibrosis and the risk of liverrelated mortality [3,4], screening strategy and defining high risk group for significant hepatic fibrosis among the average risk group are important in primary care centers. The screening strategies for hepatic fibrosis are heavily focused on patients with fatty liver on sonography or elevated liver enzyme in health check-up programs [7–9]. Routine check-up or various types of health check-up programs are performed extensively at primary care centers, there is no consensus on the target population’s need for further evaluation for significant fibrosis. This approach may have been based on the two-hit hypothesis of steatosis and oxidative stress that leads to fibrosis [10]. The presence of fatty liver and elevated liver enzymes have been considered to be central dogma in the development of hepatic fibrosis
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