Using the FIB-4, automatically calculated, followed by the ELF test in second line to screen primary care patients for liver disease

Abstract

Abstract The objective of our work was to evaluate the screening of hepatic fibrosis in primary care using the FIB-4 score, automatically calculated. When the FIB-4 was ≥ 1.3, it was defined as positive, and ELF Test was performed. FIB-4 positivity was confirmed when ELF Test was ≥ 9.8. Results: Among the 3427 patients included in primary care, 869 (25%) had a positive FIB-4 score, 784 (22.5%) at intermediate (FIB-4: 1.3–2.67), and 85 (2.5%) at high risk of fibrosis (FIB-4 > 2.67). 509 (59%) of the FIB-4 positive were confirmed by the ELF Test. The percentage of confirmation was significantly higher in patients over 65 years (83 vs. 57%), with FIB-4 > 2.67 (80 vs. 56%), BMI > 25 (47 vs. 37%), and diabetes (24 vs. 14%), p = 0.001). In patients without known liver disease (92%), the practitioner identified a cause of disease in 27% of cases: mainly NAFLD and alcohol. Conclusion: Liver fibrosis was suspected on FIB-4 in 25% of patients who consulted a general practitioner. The ELF Test, performed as a second-line, improves the screening of liver fibrosis, particularly for FIB-4 indeterminate results. A positive FIB-4 test allows physicians to recognize a liver disease, providing an opportunity for timely intervention.