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Identifying and Linking Patients At Risk for MASLD with Advanced Fibrosis to Care in Primary Care
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Journal Article
Identifying and Linking Patients At Risk for MASLD with Advanced Fibrosis to Care in Primary Care
2025
Overview
Background and Aims
Severity of fibrosis is the driver of liver-related outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD), and non-invasive testing such as fibrosis-4 (FIB-4) score is utilized for risk stratification. We aimed to determine if primary care patients at risk for MASLD and advanced fibrosis were evaluated with subsequent testing. A secondary aim was to determine if at-risk patients with normal aminotransferases had advanced fibrosis.
Methods
Primary care patients at increased risk for MASLD with advanced fibrosis (
n
= 91,914) were identified using previously established criteria. Patients with known alternative/concomitant etiology of liver disease or cirrhosis were excluded. The study cohort included patients with calculated FIB-4 score in 2020 (
n
= 52,006), and stratified into low, indeterminate, and high likelihood of advanced fibrosis. Among those at indeterminate/high risk, rates of subsequent testing were measured.
Results
Risk stratification with FIB-4 characterized 77% (
n
= 40,026) as low risk, 17% (
n
= 8847) as indeterminate, and 6% (
n
= 3133) as high risk. Among indeterminate/high-risk patients (
n
= 11,980), 78.7% (
n
= 9433) had aminotransferases within normal limits, 0.95% (
n
= 114) had elastography, and 8.2% (
n
= 984) were referred for subspecialty evaluation.
Conclusion
In this cohort of primary care patients at risk for MASLD with fibrosis, the FIB-4 score identified a substantial proportion of indeterminate/high-risk patients, the majority of which had normal aminotransferase levels. Low rates of subsequent testing were observed. These data suggest that a majority of patients at increased risk for liver-related outcomes remain unrecognized and highlight opportunities to facilitate their identification.
Publisher
Springer International Publishing
Subject
