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Metabolic dysfunction-associated fatty liver disease (MAFLD)

Metabolic dysfunction-associated fatty liver disease (MAFLD)

Referrers should use this page when referring patients to public adult hepatology outpatient services for metabolic dysfunction-associated fatty liver disease (MAFLD).
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Liver failure (rapid decline in hepatic function in patients) with red flags which include:
    • jaundice
    • ascites
    • hepatic encephalopathy
    • haematemesis (e.g. variceal bleeding)
  • Sepsis in a patient with cirrhosis
  • Spontaneous bacterial peritonitis
  • Severe ascites restricting movement and breathing or causing abdominal pain
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
  • Nil
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Abnormal LFT
  • Fatty liver seen on imaging
  • Fibrosis-4 index panel (FIB-4) score > 1.3 in the presence of suspected liver disease
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration, and severity of symptoms
  • History of Type 2 Diabetes (T2DM)
  • Alcohol consumption
  • Current medication list
Examination
  • Height and weight, or BMI
Investigations
  • FBC
  • U&E
  • LFT (including AST)
  • HBV, HCV serology
  • HbA1c
  • Fibrosis-4 index panel (FIB-4) value
  • Upper abdominal ultrasound (US) +/- liver elastography
Highly desirable
History
  • Patient and family history of liver disease and/or cardiovascular disease
  • Substance abuse history
Examination
  •  Waist circumference
Investigations
  • Previous LFT
  • Ferritin
  • Fasting lipids
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Metabolic dysfunction-associated fatty liver disease (MAFLD) with red flags (i.e. evidence of liver decompensation e.g. jaundice, ascites) and with features of cirrhosis +/- focal liver lesion

Category 2

Appointment within 90 days

  • Metabolic dysfunction-associated fatty liver disease (MAFLD) without red flags (i.e. no evidence of liver decompensation e.g. jaundice, ascites) but with features of cirrhosis
  • Fibrosis-4 index panel (FIB-4) score > 2.7

Category 3

Appointment within 365 days

  • Metabolic dysfunction-associated fatty liver disease (MAFLD) without red flags (i.e. no evidence of liver decompensation e.g. jaundice, ascites) but with evidence of liver fibrosis as defined by:
    • Fibrosis-4 index panel (FIB-4) score 1.3 – 2.7 OR
      • Hepascore ≥ 0.6 OR
      • Liver elastography score ≥ 8 kPa OR
      • Other objective evidence of liver fibrosis
Exclusions
  • Hepatic steatosis AND low risk for advanced fibrosis defined by:
    • Fibrosis-4 index panel (FIB-4) score < 1.3
    • Fibrosis-4 index panel (FIB-4) score 1.3 – 2.7 AND
      • Hepascore < 0.6 OR
      • Liver elastography score < 8 kPa
      • No features of concomitant liver disease (e.g. viral hepatitis)
Useful information
  • See Clinician Assist WA: Fatty Liver
  • Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Consensus Statement 2024
  • Fibrosis-4 calculator
  • For patients who have hepatic steatosis who do not have evidence of advanced fibrosis, recheck Fibrosis-4 index panel (FIB-4) score or other appropriate fibrosis marker every 2 to 3 years to monitor for development of significant fibrosis. If there is evidence of fibrosis please refer to Hepatology clinic
  • Clinical trial for MAFLD
    • If considering a clinical trial for MAFLD then this should be clearly stated in the referral as it is outside the general Hepatology clinic
    • Patients can be referred for potential clinical trials even if they do not meet the criteria listed in this RAC, but this also needs to be clearly stated in the referral

Medical Management

  • Manage metabolic factors
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)

Feedback

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Last reviewed: 29-04-2025

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