LIVER STIFFNESS MEASUREMENTS IN EMERGENCY TRIAGE PREDICT INPATIENT HEALTH CARE UTILIZATION

Background Transient elastography allows non-invasive quantification of liver fibrosis, steatosis or right/global heart failure by liver stiffness measurements (LSM) and controlled attenuation parameter (CAP), respectively. This study aimed to test the feasibility and utility of transient elastography in the emergency department (ED) setting and to investigate whether LSM predicts longer hospitalization and reimbursement for non-elective patients.

Methods LSM and CAP were determined in prospectively recruited consecutive adult patients admitted to the ED of a tertiary referral center. The 9.1 kPa LSM cut-off was used for the diagnosis of significant liver fibrosis (stage ≥ F2), and LSM ≥ 13.0 kPa indicated the presence of cirrhosis. Elastography measurements were correlated with clinical and outcome parameters, including duration of hospital stay and hospitalization costs based on the German Diagnosis Related Groups (DRG) system.

Results In 200 admitted patients (133 men, age 18 – 97 years), median LSM was 5.5 kPa (2.4 – 69.1 kPa), and median CAP was 252 dB/m (100 – 400 dB/m). In total, 39 patients (19.5 %) presented with LSM suggestive of significant fibrosis, and LSM indicating cirrhosis was detected in 24 patients (12.0 %). Heart failure was diagnosed in 19 patients, which was associated with higher LSM (p = 0.045). Patients with LSM ≥ 9.1 kPa were significantly (p  <  0.01) more likely to require longer hospitalization than those with lower LSM. Patients with LSM ≥ 13.0 kPa generated significantly (p = 0.001) higher costs as compared to patients with LSM  <  9.1 kPa.

Conclusions Transient elastography represents an easily accessible and anon-invasive screening tool in ED that might help identify patients with advanced liver or cardiovascular diseases in need of increased health care resources.

Publication History

Article published online:
04 January 2021