P5842 - Analysis of Primary Care Referrals for Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: Identifying High Risk Patients

Andrew A. Wang, MD, Justin Zhuo, MD, Anish V. Patel, MD, Alexander Lalos, MD
Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) prevalence is currently estimated at 38% and projected to increase to 55% by 2040. MASLD detection is often inefficient. Patients are often referred to hepatology outpatient care through primary care physicians (PCPs) as either low-risk patients or conversely as decompensated cirrhosis. In our study, we evaluated MASLD referral practices of local PCPs.

Methods: This was a retrospective cohort study of adult patients evaluated at our tertiary academic institution’s outpatient hepatology clinic utilizing ICD code K76.0 as principal diagnosis in our EMR from 2019-2023. We excluded referrals placed for reasons other than MASLD, suspicion for alcohol associated liver disease, and self-referral. We subsequently reviewed PCP performed fibrosis assessments, laboratory data, and calculated FIB-4 scores.

Results: The initial screen returned 370 patients; 206 were excluded, and 164 patients were analyzed. Most patients were referred for abnormal LFTs (53.0%) and imaging findings of hepatic steatosis (40.2%). Only 22 (17.1%) patients received any kind of fibrosis assessment prior to their appointment – of which 59.1% had F0-F1 disease. Ultimately, 129 (78.7%) patients had fibrosis testing which demonstrated mostly F0-F1 disease (82.2%), followed by F2-F3 (11.6%), and F3-F4 (6.2%). FIB-4 scores were not calculated by PCPs based on clinical documentation. 109 patients (66.5%) had FIB4 < 1.30; of these patients, 9 (8.3%) had F2 or greater disease. Their median BMI was 38.1 kg/m2 and two-thirds had type 2 diabetes.

Discussion: At our institution, most primary care referrals for MASLD were based on mild elevations in LFTs or radiologic findings of hepatic steatosis. Only a minority received any fibrosis assessment, including FIB-4 score calculation, prior to hepatology referral. Furthermore, most of them had mild disease without significant or advanced fibrosis. Our study supports the need for further usage of non-invasive testing in the primary care setting prior to specialist referral, particularly as the incidence of MASLD continues to rise. Development of clinical pathways through large healthcare systems as ours can optimize resource utilization by triaging referrals to only those with significant fibrosis, who may truly benefit from hepatology consultation. For patients with diabetes and obesity, a normal FIB-4 may underestimate their degree of liver fibrosis, and additional non-invasive fibrosis testing may be indicated.

Disclosures:
Andrew Wang indicated no relevant financial relationships.
Justin Zhuo indicated no relevant financial relationships.
Anish Patel indicated no relevant financial relationships.
Alexander Lalos indicated no relevant financial relationships.

Andrew A. Wang, MD, Justin Zhuo, MD, Anish V. Patel, MD, Alexander Lalos, MD. P5842 - Analysis of Primary Care Referrals for Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: Identifying High Risk Patients, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.