P52 Prevalence and characteristics of people with advanced chronic liver disease in primary care

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Introduction Undiagnosed steatotic liver disease is prevalent in primary care and mortality is increasing, partly due to patients being diagnosed late when treatment options are limited. There is therefore a need to develop more effective tools to detect people with liver disease in the community. SOLID was a case finding study conducted in primary care to evaluate the performance of liver fibrosis biomarkers to diagnose advanced chronic liver disease (cACLD). Our aim was to assess the prevalence and characteristics of people with previously undiagnosed cACLD in primary care. Methods Patients aged 18-80 years with obesity, T2DM, or potentially harmful alcohol use [AUDIT>8] attending an annual health review or NHS Health check were invited to participate. Those consenting had a liver assessment including liver blood tests, FIB-4 and enhanced liver fibrosis test (ELF) during the appointment. Two pathways were evaluated (Pathway 1: all patients had blood tests and a fibroscan; Pathway 2: patients were referred for a fibroscan if FIB-4 >1.3 and/or ELF >9.8). Participants with liver stiffness measurement (LSM) 8kPa had specialist hepatology review. Stage of fibrosis was determined by overall clinical assessment incorporating all tests, including repeat fibroscan and liver biopsy, where indicated. Clinical and demographic data was collected prospectively from the primary and secondary care appointments. Results Overall, 2445 individuals (mean age 58 ± 11 years, 51% male, 27% T2DM, 70% obese and 45% AUDIT score >8) had at least one liver fibrosis test. In total, 113 (4.6%) were diagnosed with moderate fibrosis, 44 (1.8%) with advanced fibrosis and 17 (0.7%) with cirrhosis (total cACLD 61 [2.5%]). The proportion of people with cACLD was 6.5% (43) in those with T2DM, 0.5% (9) with AUDIT>8 without T2DM and 1.1% (9) in those with BMI>30 (without T2DM or AUDIT >8). Table 1 shows a comparison of the characteristics of people with cACLD versus those without cACLD. After binary logistic regression, T2DM (OR 4.9), age (OR 1.01), male sex (OR 3.2) and BMI (OR 1.1) were all significantly associated with cACLD (p<0.001), however AUDIT score (p=0.264, OR 1.0) was not. Conclusions The overall prevalence of undiagnosed cACLD was 2.5% in this primary care case finding study. T2DM was the major risk factor associated with cACLD. Targeting people with T2DM for a liver fibrosis assessment during their annual review is likely to be effective in identifying undiagnosed clinically significant liver disease.

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