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
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- de Lédinghen V, Vergniol J. Transient elastography for the diagnosis of liver fibrosis. Expert Rev Med Devices. 2010;7(6):811-823.
- Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48(5):835-847.