Disposition of Patients with Significant Steatosis at a Primary Care Clinic: A Five-Year Follow-Up

ABSTRACT

Background: Fatty liver is a well-recognized health risk and epidemic. It is associated with obesity, diabetes mellitus, and metabolic syndrome. Transient elastography is a quick and simple, non-invasive tool, validated across a range of liver diseases for the assessment for fibrosis and steatosis. Using Fibroscan, liver fibrosis is assessed by liver stiffness measured (LSM) in kilopascals (kPa) and steatosis is estimated using controlled attenuation parameter (CAP). In 2017 we initiated and reported on a screening program for fatty liver and liver fibrosis using FibroScan in a primary care facility in Southern California. Aim(s) To report on the 5-year disposition of the patients who had participated in the 2017 screening program and the outcome of their management in a primary care setting in the context of COVID-19 pandemic. Method(s) Between March, 2017 and June, 2017 958 individuals attending a primary care clinic, who had no known history of liver disease agreed to be screened and had an evaluable Fibroscan. Pts were followed and managed per standard of care in the primary care setting including annual check-ups, FibroScan assessments and referral to specialists as indicated. Result(s) Of the 958 pts, 79 were lost to follow-up, 14 pts declined follow-up, and 749 are in the process of being contacted for the 5-year follow-up check. The subjects of this analysis are 116 pts who returned for follow-up. 73.2% were females;mean age was 56.1 +/-11.6years and 88.8% Hispanic. There was no significant change in Hemoglobin A1c, ALT, and AST values. However, over the 5-year period, there was an increase of more than 25% in the number of pts diagnosed with two or more metabolic syndrome risk factors including hypertension, diabetes, hyperlipidemia, and/or fatty liver. Refer to table 1 for the 5-year change in FibroScan measurements and BMI. Conclusion(s) In a pre-dominantly Hispanic community patient population with no known history of liver disease attending a primary care clinic, over 70% had significant fat infiltration of the liver;23% had significant liver fibrosis at baseline. Only 55% of pts continued to follow regularly with primary care. Over 5years with at minimum annual follow-up visit, 1) there was no change in the fat infiltration, 2) there was increase in liver stiffness measure, 3) there was significant worsening in the metabolic syndrome presentation and risk factors. Further analysis is underway to determine the impact of the COVID-19 pandemic in leading to worsening BMI, LSM, and metabolic syndrome, especially with the 2-year quarantine, isolation, TeleHealth visits. Educational programs are urgently needed to increase the awareness of patients, community, the Primary Care practices on the epidemic of fatty liver and its consequences.