Adams, Leon A;
Thiele, Maja;
Tsochatzis, Emmanouil A;
(2025)
Detecting at-risk steatotic liver disease and liver fibrosis in the community.
Hepatology
10.1097/HEP.0000000000001400.
(In press).
![[thumbnail of detecting_at_risk_steatotic_liver_disease_and.1285.pdf]](https://discovery.ucl.ac.uk/style/images/fileicons/text.png) |
Text
detecting_at_risk_steatotic_liver_disease_and.1285.pdf - Accepted Version Access restricted to UCL open access staff until 17 May 2026. Download (1MB) |
Abstract
Advanced liver fibrosis and ‘At-Risk’ metabolic dysfunction-associated steatohepatitis (At-Risk MASH) is present in 5% and 10% respectively of community based patients with steatotic liver disease (SLD) and metabolic risk factors and/or excess alcohol consumption. Identification of these patients is critical to guide prognosis and management due to their increased risk of liver decompensation and hepatocellular carcinoma. In addition, identification of At-Risk MASH will assist in targeting those eligible for pharmacotherapy. Screening pathways for detecting advanced liver fibrosis consisting of sequential FIB-4 and elastography or direct liver fibrosis biomarkers in patients with clinical risk factors are recommended, however have sub-optimal sensitivity and specificity. Biomarkers based on serum and/or elastography for At-Risk MASH have been developed in specialist centres however lack broad validation, particularly in the community. Currently a range of barriers have retarded adoption of liver fibrosis screening in primary care, including knowledge gaps regarding non-invasive testing, cost and limited access of non-invasive tests and lack of integrated ordering and reporting systems. Once target patients are identified, robust pathways for linkage to specialist care are needed. Despite these challenges, studies performed in primary care have confirmed that liver fibrosis screening programs increase the detection of unrecognized advanced liver disease and may reduce unnecessary specialist referrals. Furthermore, some data suggest community based screening of liver fibrosis in patients with metabolic dysfunction and alcohol-associated SLD is cost-effective. Wide-spread implementation of systematic evidence based diagnostic pathways in the community are needed to reduce the liver related morbidity related to SLD.
Archive Staff Only
 |
View Item |
