Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) also MASLD, formerly NAFLD

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Potentially life-threatening symptoms suggestive of:

Acute severe GI bleeding
Acute liver failure: (acutely abnormal liver blood tests in absence of cirrhosis, associated with development of coagulopathy and hepatic encephalopathy)
Sepsis in a patient with cirrhosis
Severe encephalopathy in a patient with liver disease
New significant renal dysfunction in a patient with cirrhosis

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

MAFLD with concerning features
- Evidence of liver decompensation (e.g. jaundice and/or ascites and/or encephalopathy)

Category 2

Appointment within 90 days is desirable

MAFLD without concerning features and stratified as at high – or unresolved indeterminates-risk of advance liver fibrosis
Assess MAFLD fibrosis stage: begin with first-line FIB-4 score (Fib-4 Calculator) assessment in people aged ≥35 years
- High risk: FIB-4 score ≥ 2.7 (or ≥ 2.0 in people over 65 years)
- Indeterminate-risk: FIB-4 score between 1.3-2.7. Proceed with second-line tests (liver elastography or serum fibrosis test) Refer if second-line test results are elevated or if these are unavailable

Category 3

Appointment within 365 days is desirable

Patients with MAFLD at low risk of advanced liver fibrosis on first line (FIB-4 <1.3) +/- second-line testing without additional cause of liver disease do not require hepatology referral.
Ongoing primary care management should include:
cardiometabolic risk
liver fibrosis reassessment every 2 years or annual monitoring in patients with type 2 diabetes mellitus

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

GPs seeking guidance on MAFLD assessment and management are advised to consult the Gastroenterology Society of Australia (GESA) MAFLD Consensus Statement
Manage cardiometabolic risk factors
Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
Address misuse of other substance (illicit and prescription drugs)
Consider cessation of hepatotoxic medication, complementary and alternative medicines, NSAIDs and benzodiazepines
Education: MAFLD-cirrhosis and HCC surveillance

Referral requirements

A referral may be rejected without the following information.

Essential referral information

General referral information including details of presenting issues
Comorbidities and past medical history (including cardiometabolic risk factors)
Alcohol and drug/medication history (including complementary and alternative medicines)
Height, weight and BMI
FIB-4 (Fib-4 Calculator), ELFT, FBC results less than 3 months old
HBV, HCV serology, Fasting glucose, HbA1c and fasting lipid results
Recent upper abdominal ultrasound or CT reports

Additional referral information (useful for processing the referral)

Family history of liver disease or diabetes
Record of previous liver function tests
Iron studies/INR

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use