Unscheduled medical care, including emergency room visits and GP referrals, can identify patients at high risk of advanced and decompensated liver disease (DLD). A recent retrospective cohort study highlights that a substantial number of individuals with frequent unscheduled care attendances, but no prior liver diagnosis, were later admitted to the hospital for liver disease.
Liver cirrhosis remains a leading cause of mortality in the working-age population, with UK mortality rates rising over the past decade. Shockingly, one-fifth of patients presenting with DLD have no previous diagnosis, and approximately 15% do not survive their initial hospitalization. For alcohol-related cirrhosis, about half of patients are diagnosed during hospital admission, not in primary care. UK patients with alcohol-related liver disease typically have an average of five prior unscheduled care encounters.
The study analyzed nearly 173,500 patients who attended unscheduled care between 2018 and 2020, with follow-up until 2022. Over 1,600 patients were admitted with DLD-related issues within this five-year period, indicating numerous missed opportunities for early diagnosis and intervention.
Researchers developed a predictive model using the Fibrosis 4 (FIB-4) index, geographical deprivation, and assigned sex, achieving a prediction accuracy of 0.78. However, a significant portion of the cohort was excluded due to the unavailability of blood tests for FIB-4. Those excluded, though younger on average, showed a lower proportion of subsequent DLD, suggesting that focusing on patients with available blood tests may select a higher baseline risk group.
These findings underscore the critical value of analyzing unscheduled care presentations for identifying individuals at high risk of advanced liver disease. A model incorporating simple laboratory and demographic data could significantly improve DLD detection.