Non-alcoholic fatty liver disease (NAFLD) is a significant public health concern. Rates are increasing due to increasing levels of obesity. Early identification of patients in primary could prevent progression to end stage liver failure. The aim of this project is to pilot introduction of a screen for NAFLD and liver fibrosis into the existing NHS Health Check. Simple fibrosis scores have been extensively evaluated in a secondary care setting, however their utility in primary care has not been established.Methods
Five GP practices took part in the pilot. The NHS Health Check is offered by GPs to any patient aged 40–74 years who is not already on a disease register. Patients who attended for this were screened to determine if they met the inclusion criteria. Patients were included if they had an increased BMI (≥30 or≥27.5 in high risk ethnicities) or waist circumference (>94 cm men or >90 cm men high risk ethnicities and >80 cm women) and low alcohol intake (<28 units/week males or <21 units/week females). AST/ALT ratio, Fibrosis-4-score (FIB-4) and NAFLD score were calculated for each patient. Those with an increased fibrosis score were reviewed in outpatients and had further investigations; non-invasive liver screen, liver ultrasound scan and liver elastography.Results
Out of the 82 included patients, 64 (78%) had at least one increased fibrosis score. Twenty-six patients with raised fibrosis score/s were reviewed in outpatient clinic and were offered further investigations. Of 15 patients who had an US scan 10 (66%) had fatty liver and the rest were normal. Twenty-one patients had liver elastography and 1 was found to have possible fibrosis with a fibrosis score of 8.1 kPa. Subsequent liver histology showed fibrosis, however it was thought to be drug induced.Conclusions
Informal feedback from the staff performing the NHS Health Check indicated that incorporating the liver screen was not burdensome. However, based on these Results simple fibrosis markers are not a useful screening test for use in primary care, as the high false positive rate Resulted in too many unnecessary referrals to secondary care to exclude fibrosis. It remains unclear how patients with liver fibrosis can be easily identified in primary care.