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Using the FIB-4, automatically calculated, followed by the ELF test in second line to screen primary care patients
Denis Ouzan1,2, G Penaranda3,4, M Jlaiel5
1Département d'Hépato-Gastroentérologie, Institut Arnault Tzanck, 06700, Saint-Laurent-du-Var, France. denis.ouzan@wanadoo.fr.
Insights
Screening for liver fibrosis in primary care using the FIB-4 score is effective. The Enhanced Liver Fibrosis (ELF) Test confirms results, improving early detection and intervention opportunities for patients.
Area of Science:
- Hepatology
- Primary Care Medicine
- Diagnostic Screening
Background:
- Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease are common.
- Early detection of liver fibrosis is crucial for timely intervention.
- Primary care settings offer opportunities for widespread fibrosis screening.
Purpose of the Study:
- To evaluate the effectiveness of FIB-4 score for hepatic fibrosis screening in primary care.
- To assess the role of the Enhanced Liver Fibrosis (ELF) Test as a confirmatory tool.
Main Methods:
- Automated calculation of the FIB-4 score for 3427 patients.
- FIB-4 score ≥ 1.3 triggered further testing with the ELF Test.
- ELF Test score ≥ 9.8 indicated advanced fibrosis.
Main Results:
- 25% of patients had a positive FIB-4 score (≥ 1.3).
- 59% of FIB-4 positive results were confirmed by the ELF Test.
- Confirmation rates were higher in older patients, those with higher FIB-4 scores, BMI > 25, and diabetes.
Conclusions:
- FIB-4 score is a valuable tool for identifying patients needing further liver fibrosis assessment in primary care.
- The ELF Test enhances screening accuracy, especially for intermediate FIB-4 results.
- This approach facilitates early recognition of liver disease, enabling prompt management.
Abstract:
The objective of our work was to evaluate the screening of hepatic fibrosis in primary care using the FIB-4 score, automatically calculated. When the FIB-4 was ≥ 1.3, it was defined as positive, and ELF Test was performed. FIB-4 positivity was confirmed when ELF Test was ≥ 9.8 indicating an advanced fibrosis. Among the 3427 patients included, 869 (25%) had a positive FIB-4 score, 784 (22.5%) at intermediate (FIB-4: 1.3-2.67), and 85 (2.5%) at high risk of fibrosis (FIB-4 > 2.67). 509 (59%) of the FIB-4 positive were confirmed by the ELF Test. The percentage of confirmation was significantly higher in patients over 65 years (83 vs. 57%), with FIB-4 > 2.67 (80 vs. 56%), BMI > 25 (47 vs. 37%), and diabetes (24 vs. 14%), p = 0.001). In patients without known liver disease (92%), the practitioner identified a cause of disease in 27% of cases: mainly NAFLD and alcohol. Liver fibrosis was suspected on FIB-4 in 25% of patients in primary care. The ELF Test, performed as a second-line, improves the screening of liver fibrosis, particularly for FIB-4 intermediate results. A positive FIB-4 test allows physicians to recognize a liver disease, providing an opportunity for timely intervention.Clinical trial registration: Comité de protection des personnes du sud-ouest et outre-mer SI18.00832.201865-MS04-IDRCB 2018-A01571-54.
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