Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

• Published in: Hepatology communications 2024-07, Vol.8 (7)
• Main Authors: Prince, David S, Hoque, Shakira, Kim, Christy, Maher, Salim, Miller, Jane, Chomley, Phoebe, Pritchard-Jones, Janice, Spruce, Sally, McGarry, Nathan, Baker, David, Elix, Penelope, Liu, Ken, Strasser, Simone I, Goodger, Brendan, Zekry, Amany, McCaughan, Geoffrey W
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aspartate Aminotransferases - blood; Chronic Disease; Elasticity Imaging Techniques; Female; General Practice; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Diseases - diagnosis; Male; Mass Screening - methods; Middle Aged; Platelet Count; Software
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1097/HC9.0000000000000482

Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression. A cloud-based software solution ("the Liver Toolkit") was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded. Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0-9.9 kPa] and 77% low risk of fibrosis [LSM