Gap in Care: Follow-up of Incidental Hepatic Steatosis in an Urban Safety-net Hospital.

GOALS: This study evaluated the follow-up rates for incidental hepatic steatosis detected via imaging at an urban safety-net hospital.

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and liver transplantation. Despite its growing prevalence, incidental hepatic steatosis identified by imaging is frequently overlooked in clinical practice.

STUDY: We retrospectively reviewed 300 adult patients diagnosed with incidental hepatic steatosis between 2019 and 2020. Comorbidities and follow-up actions such as LFTs, hepatology referral, transient elastography, insurance, and demographic information were extracted by manual chart review. Comparisons were made between patients diagnosed in the emergency department (ED) and outpatient settings.

RESULTS

Among 300 patients with incidentally identified hepatic steatosis, demographic factors (age, race, BMI) and frequency of abnormal LFT were similar between ED and outpatient cohorts. While hypertension and hyperlipidemia were more prevalent in outpatients, ED patients predominantly presented with mild steatosis (95.3%) compared with higher rates of moderate-to-severe disease in the outpatient group (P <0.001). Overall, 41% of the cohort received no follow-up, and follow-up rates did not significantly differ by age, race, or insurance type. Notably, outpatients were associated with significantly higher utilization of transient elastography (10.2% vs. 2.8%, P=0.02) and a trend toward more frequent hepatology referral compared with ED patients.

CONCLUSION

Most patients with incidental hepatic steatosis did not undergo an appropriate evaluation. Greater awareness among ED and primary care providers is required to address this growing public health issue.