Whether Screening for Non-alcoholic Fatty Liver Disease in Patients With Psoriasis Is Necessary: A Pilot Quality Improvement Project.
cirrhosis
non-alcoholic fatty liver disease
psoriasis
quality improvement
transient elastography (fibroscan)
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
accepted:
03
05
2022
entrez:
6
5
2022
pubmed:
7
5
2022
medline:
7
5
2022
Statut:
epublish
Résumé
Background Psoriasis is a chronic inflammatory skin disease that is strongly associated with non-alcoholic fatty liver disease (NAFLD). Both conditions are associated with excess cardiovascular and liver-related morbidity and mortality. The severity of psoriasis correlates with the degree of liver inflammation and scarring, which can be further exacerbated by systemic immunomodulators such as methotrexate. Currently, no clinical pathway exists to screen psoriasis patients for NAFLD in our Trust. We aimed to develop a shared clinical pathway between our hepatology and dermatology departments to allow early identification and management of NAFLD in this patient group. Methods A multidisciplinary team was assembled to identify patient priorities, management goals, and screening criteria. We identified gaps in our service and reviewed current clinical best practice guidelines. A clinical pathway was developed using a process map and revised according to feedback received. We piloted this pathway on a prospective cohort of psoriasis patients identified by our dermatology department. Patients were invited for transient elastography if fatty liver was identified on an ultrasound scan. Baseline demographics, biochemistry and imaging results were collected and analysed. Results Of 57 psoriasis patients, 30 (52.6%) had sonographic evidence of hepatic steatosis. The median age was comparable between groups with 56 and 55 years in the psoriasis-NAFLD (Ps-NAFLD) and no-NAFLD groups respectively. There were more males in the Ps-NAFLDgroup (56.7%) compared to the no-NAFLD group (37%). Fifteen out of 30 patients were eligible for transient elastography (two were excluded due to body habitus). Seven (53.8%) patients had no-to-mild fibrosis indicated by liver stiffness measurement (LSM)
Identifiants
pubmed: 35518363
doi: 10.7759/cureus.24714
pmc: PMC9065945
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e24714Informations de copyright
Copyright © 2022, Torbator et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Hepatol. 2009 Oct;51(4):778-86
pubmed: 19664838
Liver Int. 2010 Apr;30(4):546-53
pubmed: 20074094
J Hepatol. 2020 Jul;73(1):202-209
pubmed: 32278004
Int J Mol Sci. 2016 Feb 05;17(2):217
pubmed: 26861300
Actas Dermosifiliogr. 2017 Jul - Aug;108(6):506-514
pubmed: 28318525
Br J Dermatol. 2016 Jul;175(1):23-44
pubmed: 27484275
Clin Liver Dis (Hoboken). 2019 Apr 30;13(4):114-116
pubmed: 31061705
J Am Acad Dermatol. 2014 Mar;70(3):517-24
pubmed: 24373781
Hepatol Commun. 2021 Jan 14;5(5):749-759
pubmed: 34027266
PLoS One. 2017 Jul 18;12(7):e0181039
pubmed: 28719618
Liver Int. 2007 Jun;27(5):639-45
pubmed: 17498249
Sci Rep. 2019 Jul 31;9(1):11124
pubmed: 31366982
Hepatology. 2018 Jan;67(1):123-133
pubmed: 28802062
World J Gastroenterol. 2017 Dec 21;23(47):8263-8276
pubmed: 29307986
Hepatology. 2007 Apr;45(4):846-54
pubmed: 17393509
Hepatology. 2010 Feb;51(2):454-62
pubmed: 20101745
Expert Rev Gastroenterol Hepatol. 2019 Apr;13(4):361-374
pubmed: 30791772