Improving the Diagnosis and Fibrosis Risk Assessment of Nonalcoholic Fatty Liver Disease in Primary Care Patients with Abnormal Liver Chemistries
改善肝脏化学异常的初级保健患者非酒精性脂肪肝的诊断和纤维化风险评估
基本信息
- 批准号:10616810
- 负责人:
- 金额:$ 11.33万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-05-15 至 2024-08-31
- 项目状态:已结题
- 来源:
- 关键词:AbdomenAcuteAddressAdultAge YearsAlcoholic Liver DiseasesAlcoholsBiometryCardiovascular systemCause of DeathCessation of lifeChemistryChronicCirrhosisClinicalCodeCommunitiesDataDeath RateDiabetes MellitusDiagnosisDiagnosticDiagnostic ErrorsDiseaseDisease ManagementDisease OutcomeDisease modelEarly DiagnosisElectronic Health RecordElementsEndocrinologyEpidemiologyEvaluationFatty LiverFibrosisFutureGoalsHealth Services ResearchHepatitis BHepatitis CHepatitis C virusHepatologyHigh PrevalenceHypertensionImageK-Series Research Career ProgramsLinkLiverLiver FailureLiver diseasesMeasurementMeasuresMediatingModelingObesityOutcomePatientsPerformancePortal HypertensionPrevalencePrimary CarePrimary carcinoma of the liver cellsRecording of previous eventsResearchResearch PersonnelRiskRisk AssessmentRisk FactorsSamplingSeveritiesSignal TransductionSigns and SymptomsSpecificitySteatohepatitisStep TestsTechnologyTestingTimeTrainingTransaminasesTreatment EfficacyViral hepatitisWorkalcohol exposurechronic liver diseasecohortdiagnostic strategydisease diagnosisdisease diagnosticeffective therapyeffectiveness evaluationelastographyend stage liver diseasefollow-uphealth economicshigh riskimprovedindexingliver stiffnessmedical specialtiesmortalitynon-alcoholic fatty liver diseasepredictive modelingprimary care patientprimary care settingradiological imagingresponsesimple steatosissupport toolstertiary careultrasoundvibration
项目摘要
Abstract
Improving the Diagnosis and Fibrosis Risk Assessment of Nonalcoholic Fatty Liver Disease in Primary
Care Patients with Abnormal Liver Chemistries.
Chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), alcohol-related liver disease (ALD),
and viral hepatitis, often go undetected in their early stages, a diagnostic delay directly harmful to patients.1,2
Pervasive diagnostic error fuels the climbing toll of chronic and end-stage liver disease, despite the increasing
availability and efficacy of therapeutic options.3
Liver chemistry elevations may signal chronic liver disease, and systematic responses to these abnormalities
can lead to earlier disease recognition and delivery of effective treatment.4-11 Currently, responses to abnormal
liver tests in primary care lack consistency and contribute to diagnostic error.11-17 Our K23 work found nearly
12% of patients with abnormal liver tests lacked repeat assessment, and only 16% of patients with consecutive
liver test abnormalities received timely viral hepatitis C testing.14,16 These limited and inconsistent evaluations
challenge our ability to develop models linking patient-level variables to liver disease diagnoses.
Diagnosing NAFLD poses unique challenges, as the diagnosis requires a negative alcohol exposure history, a
comprehensive ruling out of other liver conditions, and/or abdominal imaging, elements inaccessible or absent
in electronic health records.11,18 Despite primary care-based risk factors including obesity, hypertension, and
diabetes, NAFLD remains underdiagnosed in this setting.18-22 Our K23 work highlights the severity of this
underdiagnosis, as only 31% of patients with radiographic evidence of hepatic steatosis and no known (non-
NAFLD) chronic liver disease (n=767) ever received a diagnosis code for NAFLD.
Beyond diagnosis, NAFLD management in primary care requires fibrosis risk assessment because the presence
of advanced fibrosis is the best indicator of liver-related, cardiovascular, and overall mortality in these patients.23-
25 Current fibrosis risk assessments begin with non-invasive risk scores, including the Fibrosis-4 index (FIB-4)
and the NAFLD Fibrosis score (NFS), to identify patients most likely to benefit from hepatology referral.6,18,26-28
FIB-4 and NFS were developed and tested in specialty and tertiary care cohorts and may perform differently in
primary care. When we applied FIB-4 and NFS to our limited primary care NAFLD cohorts, the results revealed
an abundance of high-risk scores, were often discrepant, and would have resulted in conflicting clinical decisions
for 30% of the sample. Follow-up testing with liver stiffness measurement by vibration-controlled elastography
can improve non-invasive test accuracy, but this technology is not currently available in primary care.29,30
In this proposal, the investigators seek to deploy a proactive diagnostic strategy to improve the primary care
diagnosis of NAFLD (Aim 1) and evaluate EHR-based, patient-level clinical variables associated with a high-risk
for advanced fibrosis identified by non-invasive risk scores and vibration-controlled elastography (Aim 2).
摘要
改善原发性非酒精性脂肪肝的诊断和纤维化风险评估
护理肝脏化学异常的患者。
慢性肝病,包括非酒精性脂肪性肝病(NAFLD)、酒精相关性肝病(ALD),
和病毒性肝炎,往往在早期未被发现,诊断延误直接损害患者。
普遍存在的诊断错误助长了慢性和终末期肝病的攀升,尽管越来越多的
治疗选择的可用性和有效性。
肝化学升高可能提示慢性肝病,以及对这些异常的系统反应
可以导致早期疾病识别和有效治疗的交付。4 -11目前,对异常
初级保健中的肝脏检查缺乏一致性,并导致诊断错误。11 -17我们的K23工作发现,
12%的肝功能检查异常的患者缺乏重复评估,只有16%的连续肝功能检查异常的患者缺乏重复评估。
肝功能检查异常及时接受丙型肝炎病毒检测。14,16这些有限且不一致的评估
挑战我们开发将患者水平变量与肝病诊断联系起来的模型的能力。
诊断NAFLD带来了独特的挑战,因为诊断需要阴性酒精暴露史,
全面排除其他肝脏疾病,和/或腹部成像,无法获得或不存在的元素
11,18尽管基于初级保健的风险因素包括肥胖,高血压,
在这种情况下,NAFLD仍然诊断不足。18 -22我们的K23工作强调了这种情况的严重性。
诊断不足,因为只有31%的患者有肝脂肪变性的放射学证据,
NAFLD)慢性肝脏疾病(n=767)曾接受过NAFLD的诊断代码。
除了诊断,在初级保健中的NAFLD管理需要纤维化风险评估,因为
晚期纤维化的发生率是这些患者肝脏相关、心血管和总体死亡率的最佳指标。
25目前的纤维化风险评估开始采用非侵入性风险评分,包括纤维化-4指数(FIB-4)
和NAFLD纤维化评分(NFS),以确定最有可能从肝病治疗中获益的患者。6,18,26 -28
FIB-4和NFS是在专科和三级护理队列中开发和测试的,
初级保健.当我们将FIB-4和NFS应用于我们有限的初级保健NAFLD队列时,结果显示,
大量的高风险评分,往往是不一致的,并会导致相互矛盾的临床决策
30%的样本。通过振动控制弹性成像测量肝脏硬度的随访测试
可以提高非侵入性检测的准确性,但目前初级保健中还没有这项技术。
在这项提案中,研究人员试图部署一个积极的诊断策略,以改善初级保健
诊断NAFLD(目标1),并评估与高风险NAFLD相关的基于EHR的患者水平临床变量。
通过非侵入性风险评分和振动控制弹性成像确定的晚期纤维化(目的2)。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Andrew David Schreiner其他文献
Andrew David Schreiner的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Andrew David Schreiner', 18)}}的其他基金
Improving the Diagnosis and Fibrosis Risk Assessment of Nonalcoholic Fatty Liver Disease in Primary Care Patients with Abnormal Liver Chemistries
改善肝脏化学异常的初级保健患者非酒精性脂肪肝的诊断和纤维化风险评估
- 批准号:
10452095 - 财政年份:2022
- 资助金额:
$ 11.33万 - 项目类别:
Improving the Diagnosis of Liver Disease in Primary Care Patients with Abnormal Liver Function
改善肝功能异常的初级保健患者的肝病诊断
- 批准号:
10163178 - 财政年份:2018
- 资助金额:
$ 11.33万 - 项目类别:
Improving the Diagnosis of Liver Disease in Primary Care Patients with Abnormal Liver Function
改善肝功能异常的初级保健患者的肝病诊断
- 批准号:
10359758 - 财政年份:2018
- 资助金额:
$ 11.33万 - 项目类别:
相似海外基金
Transcriptional assessment of haematopoietic differentiation to risk-stratify acute lymphoblastic leukaemia
造血分化的转录评估对急性淋巴细胞白血病的风险分层
- 批准号:
MR/Y009568/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Fellowship
Combining two unique AI platforms for the discovery of novel genetic therapeutic targets & preclinical validation of synthetic biomolecules to treat Acute myeloid leukaemia (AML).
结合两个独特的人工智能平台来发现新的基因治疗靶点
- 批准号:
10090332 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Collaborative R&D
Acute senescence: a novel host defence counteracting typhoidal Salmonella
急性衰老:对抗伤寒沙门氏菌的新型宿主防御
- 批准号:
MR/X02329X/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Fellowship
Cellular Neuroinflammation in Acute Brain Injury
急性脑损伤中的细胞神经炎症
- 批准号:
MR/X021882/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Research Grant
KAT2A PROTACs targetting the differentiation of blasts and leukemic stem cells for the treatment of Acute Myeloid Leukaemia
KAT2A PROTAC 靶向原始细胞和白血病干细胞的分化,用于治疗急性髓系白血病
- 批准号:
MR/X029557/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Research Grant
Combining Mechanistic Modelling with Machine Learning for Diagnosis of Acute Respiratory Distress Syndrome
机械建模与机器学习相结合诊断急性呼吸窘迫综合征
- 批准号:
EP/Y003527/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Research Grant
FITEAML: Functional Interrogation of Transposable Elements in Acute Myeloid Leukaemia
FITEAML:急性髓系白血病转座元件的功能研究
- 批准号:
EP/Y030338/1 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Research Grant
STTR Phase I: Non-invasive focused ultrasound treatment to modulate the immune system for acute and chronic kidney rejection
STTR 第一期:非侵入性聚焦超声治疗调节免疫系统以治疗急性和慢性肾排斥
- 批准号:
2312694 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Standard Grant
ロボット支援肝切除術は真に低侵襲なのか?acute phaseに着目して
机器人辅助肝切除术真的是微创吗?
- 批准号:
24K19395 - 财政年份:2024
- 资助金额:
$ 11.33万 - 项目类别:
Grant-in-Aid for Early-Career Scientists
Acute human gingivitis systems biology
人类急性牙龈炎系统生物学
- 批准号:
484000 - 财政年份:2023
- 资助金额:
$ 11.33万 - 项目类别:
Operating Grants