# Improving the Diagnosis and Fibrosis Risk Assessment of Nonalcoholic Fatty Liver Disease in Primary Care Patients with Abnormal Liver Chemistries

> **NIH NIH R03** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2022 · $113,188

## Abstract

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-base...

## Key facts

- **NIH application ID:** 10452095
- **Project number:** 1R03DK129558-01A1
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Andrew David Schreiner
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $113,188
- **Award type:** 1
- **Project period:** 2022-05-15 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10452095

## Citation

> US National Institutes of Health, RePORTER application 10452095, Improving the Diagnosis and Fibrosis Risk Assessment of Nonalcoholic Fatty Liver Disease in Primary Care Patients with Abnormal Liver Chemistries (1R03DK129558-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10452095. Licensed CC0.

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