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Omitted Liver Disease Screening in Acute Coronary Syndrome (ACS) Hides Prevalence of High Levels of Severe Liver Fibrosis

Saliu D, Veys S, Reynolds RC, Mandour O Mandour, Oben JA

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) has important associations with the metabolic syndrome and shares features with cardiovascular diseases, such as acute coronary syndrome (ACS). It is not standard of care to screen ACS patients for liver disease. We sought, to determine what proportion of patients presenting with ACS had full liver functions tests (LFTs) performed, and using available LFTs assessed for liver fibrosis.

Methods: Retrospective study of patients admitted with ACS to St Thomas’ teaching hospital between 01/09/17 and 31/08/18. We determined if full LFTs had been measured to allow calculation of a fibrosis score. As a secondary outcome we audited metabolic parameters for each patient. This study was exempt from IRB review.

Results: 360/521 patients (69%) met inclusion criteria of having an acute admission due to ACS: 272 males and 88 females, aged 34-91. 181(50%) had an ST elevation Myocardial infarction (STEMI), 176(49%) had a Non-ST elevation Myocardial Infarction (NSTEMI), and 3 had an unspecified ACS. 30 (8.3%) had sufficient tests performed to calculate FIB-4; 263(72%) had basic LFTs performed, and 67(19%) had no LFTs measured. Of the 30 with sufficient tests, 47% had a FIB-4 score >3.25, indicating advanced liver fibrosis (bridging fibrosis or cirrhosis). Only 2 had pre-existing known liver disease including NAFLD.

Conclusion: Few patients presenting with ACS are assessed for liver fibrosis. A change in standard of care to performing a full liver screen on patients admitted with ACS would allow for the increased diagnosis of liver fibrosis.