Introduction Non-alcoholic fatty liver disease (NAFLD) affects approximately 1 in 4 adults in the UK.1In our hospital catchment area there are an estimated 150000 individuals with NAFLD, approximately 12000 of who are likely to have advanced liver fibrosis. Our aim was to evaluate the utility of a weekly nurse-led NAFLD clinic including transient elastography (Fibroscan; TE) to screen for advanced fibrosis in the management of rising numbers of referrals to our secondary care Hepatology clinics.
Method A designated referral pathway was devised in conjunction with local primary care commissioners where patients with suspected NAFLD and with a NAFLD-fibrosis score2in the indeterminate or high risk range (>–1.455) were assessed in a one-stop clinic by a clinical nurse specialist using a specific clerking template. TE was performed on all patients with NAFLD and discharge to primary care with lifestyle advice considered in those with TE values below the threshold for advanced liver fibrosis/cirrhosis (7.9 kPa).3Prospective demographic and clinical data were collected on all patients seen in the clinic from May 1st–Dec 31st2014.
Results A total of 112 patients were seen during the evaluation period; Male:Female 3:2, median age 59 years (range 20–91). Thirteen (12%) consumed alcohol at levels above those consistent with a diagnosis of NAFLD (females >14 units/week; males >21 units/week), 2 (1.8%) had autoimmune hepatitis and 2 (1.8%) had chronic hepatitis C. The remaining 95 (85%) were diagnosed with NAFLD. Amongst this NAFLD population, TE values <7.9 kPa were present in 56 patients (59%), 43 of whom were discharged to primary care. This represented 45% of the NAFLD patients and 38% of all referrals made. Thirteen NAFLD patients had TE readings <7.9 kPa but were followed up in consultant clinics for other clinical reasons. Thirty-three patients (35%) had TE readings ≥7.9 kPa, all of whom were followed-up in consultant clinics, as well as 6 patients (6%) in whom TE was unreliable.
Conclusion A one-stop nurse-led clinic for patients with suspected NAFLD and an indeterminate or high NAFLD fibrosis score allowed early discharge of approximately 40% of the patients referred. Such clinics may be a useful way of stratifying patient risk and utilising resources effectively in the face of increasing demand on secondary care Hepatology services.
Disclosure of interest None Declared.
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Angulo P, et al. Hepatology 2007;45:846–54
Wong VW, et al. Hepatology 2010;51:454–62
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