6 responses to “Use of non-invasive tests for liver fibrosis”

  1. Additional comments from the authors:

    Patients who are at the highest risks of liver fibrosis and how to assess the risk:

    Any factor that causes inflammation in the liver over time can lead to liver fibrosis, i.e. alcohol, fatty liver, hepatitis B, C, autoimmune and metabolic liver disease, etc. As liver fibrosis can be insidious and serum scores are quite cost-effective, you could consider them in patients with known or suspected liver disease to assess for fibrosis. As stated in the article, care would have to be taken to ensure there are no confounding factors such as acute hepatitis.

    It is hard to estimate the risk in terms of death or liver failure as the non-invasive tests can only stratify patients into low risk or high risk of liver fibrosis (with the intention of guiding further investigations and management, such as referral to a specialist); more information would be required to confirm if the patient has cirrhosis and predict survival in cirrhosis. Paragraph 1 of “what I recommend (practice tips)” discusses this role of non-invasive testing.

    Transient elastography:

    The cut-offs are rough cut-offs for no fibrosis and likely advanced fibrosis for most liver disease, but each liver condition will have a slightly different cut-off and the hepatologist should provide the interpretation and recommendation. If one patient has some fibrosis (i.e. intermediate zone 7–14 kPa), treating the underlying liver cause would help to prevent or slow the fibrosis process. E.g. if someone has fatty liver, clearly losing some weight by healthy diet and regular exercise will help; if someone drinks alcohol, they should cut down or even quit drinking, etc.

    Referrals for transient elastography (TE):

    There are different ways that one can refer a patient for transient elastography (TE). Most hepatologists have access to TE and referring the patient to one of the hepatologists is one way. There are some clinics or diagnostic facilities that might offer TE, but there might be some costs. When referring a patient for TE, it would be useful to include background history (past medical history and liver specific), lab results, and reasons for transient elastography, which would be helpful for the specialist to properly triage the referral or urgency for TE.

    What is the percentage of patients in family practice will this apply to?

    Studies in Canada have shown that approximately 25-30% of the general population has NAFLD, however specifically for liver fibrosis, which can occur with any etiology that can cause inflammation in the liver, the percentage of patients in a family practice would depend on the type of practice.

  2. Thanks for this helpful piece. Can you clarify what the likely benefits are to patients of referral for specialist management of fibrosis when the cause is alcohol or NAFLD, other causes have been ruled out, and all available support is being provided for AUD and/or obesity? Many thanks.

  3. This is super helpful and I will definitely be applying FIb-4 and Apri scores to my patients

  4. Thank you so much for this . It is really helpful.

  5. Thanks for the question. Patients with high risk of advanced fibrosis or progression of fibrosis/cirrhosis might benefit from seeing specialists to have a baseline fibrosis assessment and assess/address all possible factors leading to fibrosis (though we recognize that this is often done well by PCPs as you mention management for AUD/obesity). Although there is no approved treatment for fatty liver disease, there are some emerging treatments and clinical trials. Specific benefits would be depend on the individual patient case.

  6. Fantastic article, cheers.

Leave a Reply