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

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

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