Liver Stiffness Measurement as a Potential Screening Tool for Liver-Related Events in HCV

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 The risk for cirrhosis was no different between the community and hospital cohorts.
The risk for cirrhosis was no different between the community and hospital cohorts.

The rate of advanced liver fibrosis in the community appears to be significant (16.5%) and often underdiagnosed; therefore, liver stiffness measurement is a feasible community screening tool that can be used to predict liver-related events, according to a study published in the Journal of Hepatology.1

Chronic hepatitis C is a major health issue that is responsible for more than 1.34 million deaths worldwide annually.2 Although early identification is associated with improved survival,3-5 many patients with chronic hepatitis C infection are managed solely in primary care settings.6 Liver stiffness measurement is a well-validated tool for detecting advanced fibrosis and cirrhosis in chronic hepatitis C in tertiary and specialist centers.7-14 

To determine its use in the community, researchers prospectively recruited a community cohort of 780 adult patients with chronic hepatitis C infection from 21 primary care practices in Australia and compared their data with data from a hospital cohort of 272 newly referred patients with chronic hepatitis C infection from one tertiary center.1 The primary outcome of the study was the prevalence of advanced fibrosis/cirrhosis, as defined by a liver stiffness measurement of ≥12.5 kPa. 

They found that the median liver stiffness measurement was 6.9 kPa in the community, with 16.5% of patients at risk for advanced fibrosis. Interestingly, of these patients, 8.5% had no laboratory features of advanced liver disease, and yet liver-related events occurred in 9.3% over a median follow-up of 15.2 months. They also found that the risk for cirrhosis was no different between the community and hospital cohorts (P =.169), and that independent predictors of elevated liver stiffness measurement included at-risk alcohol consumption, advancing age, elevated body mass index, and alanine transaminase. 

“We have highlighted a gap in primary care management with a significant proportion of those with advanced fibrosis remaining undetected. Our study suggests a comprehensive community based [chronic hepatitis C] screening program is feasible and may identify those at risk of liver related events and HCC” concluded the authors.1

References

  1. Bloom S, Kemp W, Nicoll A, et al. Liver stiffness measurement in the primary care setting detects high rates of advanced fibrosis and predicts liver related events in hepatitis C [published online April 27, 2018]. J Hepatol. doi: 10.1016/j.jhep.2018.04.013
  2. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013.Lancet. 2016;388(10049):1081-1088.
  3. Giannini EG, Cucchetti A, Erroi V, Garuti F, Odaldi F, Trevisani F. Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it?World J Gastroenterol. 2013;19(47):8808-8821.
  4. Hong T, Gow P, Fink MA, et al. Hepatocellular carcinoma surveillance is associated with improved survival and can be targeted to high risk populations. AASLD LiverLearning. 2015;109686.
  5. Ratib S, Fleming KM, Crooks CJ, Aithal GP, West J. 1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998-2009: a large population study.J Hepatol. 2014;60(2):282-289.
  6. Sievert W, Razavi H, Estes C, et al. Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C-related liver disease and costs in Australia.J Gastroenterol Hepatol. 2014;29 Suppl 1:1-9.
  7. Sandrin L, Fourquet B, Hasquenoph J-M, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis.Ultrasound Med Biol. 2003;29:1705-1713.
  8. Castéra L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.Gastroenterology. 2005;128(2):343-350.
  9. Marcellin P, Ziol M, Bedossa P, et al. Noninvasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int. 2009;29(2):242-247.
  10. Sporea I, Şirli R, Deleanu A, et al. Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study.World J Gastroenterol. 2010;16(38):4832-4837.
  11. Ziol M, Handra-Luca A, Kettaneh A, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41(1):48-54.
  12. Viganò M, Paggi S, Lampertico P, et al. Dual cut-off transient elastography to assess liver fibrosis in chronic hepatitis B: a cohort study with internal validation.Aliment Pharmacol Ther. 2011;34(3):353-362.
  13. de Lédinghen V, Vergniol J. Transient elastography for the diagnosis of liver fibrosis. Expert Rev Med Devices. 2010;7(6):811-823.
  14. Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48(5):835-847.
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