Cause and severity of patients referred to a university specialty outpatient clinic for unclear hepatopathy

Background Elevated liver enzymes are a frequent finding in the German population. Misdiagnosis of the underlying liver disease may enhance progressive liver impairment, but data regarding the etiology and extent of fibrosis are lacking. In 2019, we established a specialized outpatient clinic where primary care physicians can refer patients with unclear hepatopathy.

Methods Retrospective analysis of all patients presenting to the outpatient clinic between 01. January and 31 December 2019. All patients received serologic testing for viral and autoimmune liver disease, for M. Wilson, hemochromatosis and alpha 1 deficiency. Abdominal ultrasound and liver stiffness measurement (LSM; Fibrocan) completed diagnostic workup.

Results A total of n=597 patients were analyzed. Nonalcoholic fatty liver disease (NAFLD, n=237); alcoholic liver disease (ALD, n=51), primary biliary cholangitis (PBC, n=26), and autoimmune hepatitis (AIH, n=21) were the most prevalent diseases. According to fibroscan moderate fibrosis (F; F≥2°) was found in NALFD n=25 (10%), ALD n=16 (31%), PBC n=5 (19%), AIH n=7 (33%). Severe fibrosis was present in: NAFLD n=37 (16%); ALD n=2(4%); PBC n=2 (9%) and AIH n=3 (14%)).

Conclusion In this cohort study, NAFLD was the most prevalent liver disease and was associated with the highest rate of consecutive liver fibrosis. Furthermore, proportion of severe fibrosis was highest in patients with initial diagnosis of autoimmune liver disease (AIH, PBC). Since NAFLD is a preventable disease and autoimmune liver disease requires medical treatment to prevent disease progression, patients with unexplained hepatopathy should timely receive a structured diagnostic workup.

Publication History

Article published online:
23 January 2024