The presence of diabetes impacts liver fibrosis and steatosis by transient elastography in a primary care population

BackgroundA non-invasive method to assess liver fibrosis by measuring liver stiffness with transient elastography (TE) has been recently introduced. The role of TE among chronic hepatitis B (CHB) patients in starting antiviral therapy in the primary care setting is still controversial because of its high cost. The AST to platelet ratio index (APRI) could be a much cheaper alternative.ObjectivesThis study compares the diagnostic accuracy of TE and APRI in assessing liver fibrosis in CHB patients.Patients and MethodsA cross-sectional study in CHB patients intending to start antiviral treatment. Liver fibrosis was staged according to the METAVIR scoring system. Liver stiffness was measured by TE performed on the same day with liver biopsy, while APRI was calculated as follows: APRI=(AST/upper limit of normal)×100/platelet count (109/l). Cutoff levels of liver stiffness and APRI were calculated by using the receiver operating characteristic curve to detect significant liver fibrosis, defined as fibrosis stage F2 or more.Results117 patients were enrolled in the study; their mean age was 40.6±10.97 years. The median liver stiffness was 5.9 kPa (2.5–48 kPa) and the median APRI was 0.239 (0.09–2.73). The cutoff level of liver stiffness was 5.85 kPa for ≥F2 with an AUC of 0.614, 60.3% sensitivity, 63.6% specificity, 73.3% PPV, 49.1% NPV and a LR+ of 1.66. The APRI cutoff level was 0.235 for F≥2 with an AUC of 0.693, 64.4% sensitivity, 70.5% specificity, 78.3% PPV, 54.4% NPV and a LR+ of 2.18. Both methods gave comparable diagnostic accuracy.ConclusionAPRI is a useful marker to screen liver fibrosis in the primary care setting when TE is not available.

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Prospective screening of liver fibrosis in a primary care cohort using systematic calculation of fib-4 in routine results

PLoS ONE ◽

10.1371/journal.pone.0254939 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254939

Author(s):

Philippe Halfon ◽

Christelle Ansaldi ◽

Guillaume Penaranda ◽

Laurent Chiche ◽

Patrick Dukan ◽

...

Keyword(s):

Primary Care ◽

Liver Fibrosis ◽

Daily Practice ◽

Blood Analysis ◽

Public Health Issue ◽

Advanced Fibrosis ◽

Systematic Calculation ◽

Primary Care Population ◽

Non Invasive ◽

Routine Blood

Background & aim Liver fibrosis screening in primary care population is a major public health issue. The FIB-4 index is a simple non-invasive fibrosis test combining age, transaminases, platelets count, developed for the diagnosis of advanced fibrosis. The aim of our study was to evaluate the interest of liver fibrosis screening using systematic calculation of FIB-4 in routine blood analysis. Methods Between December 2018 and May 2019, we conducted a prospective screening of liver fibrosis in 134 158 patients during a medical check-up including routine blood analysis. Among these patients, 29 707 had transaminases and platelets counts available and benefited from an automatic calculation of FIB-4. Results were obtained from 21 French clinical laboratories in the Bouches du Rhône region. Results Among the 29 707 patients, 2161 (7.3%) had a high risk of advanced fibrosis (FIB-4>2.67). Individual investigation of patients with FIB-4>2.67 allowed to screen 1268 (1268/2161: 58.7%) patients who were not managed for any liver disease. Conclusions This work demonstrates the interest of FIB-4 for the screening of liver fibrosis in primary care population. Although additional clinical validation study is required to determine the utility and applicability of Fib-4 to daily practice, our study strongly supports this easy-to-implement strategy using a simple Fib-4 measure resulting from the use of available routine test results.

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Prospective screening of liver fibrosis in a primary care cohort using systematic calculation of fib-4 in routine results

10.1101/2021.01.13.21249262 ◽

2021 ◽

Author(s):

Philippe Halfon ◽

Christelle Ansaldi ◽

Guillaume Penaranda ◽

Laurent Chiche ◽

Patrick Dukan ◽

...

Keyword(s):

Primary Care ◽

Liver Fibrosis ◽

Blood Analysis ◽

Public Health Issue ◽

Systematic Calculation ◽

The Public ◽

For Profit ◽

Primary Care Population ◽

Non Invasive ◽

Routine Blood

AbstractBackground & AimLiver fibrosis screening in primary care population is a major public health issue. The FIB-4 index is a simple non-invasive fibrosis test combining age, transaminases, platelets count, developed for the diagnosis of advanced fibrosis. The aim of our study was to evaluate the interest of liver fibrosis screening using systematic calculation of FIB-4 in routine blood analysis.MethodsBetween December 2018 and May 2019, we conducted a prospective screening of liver fibrosis in 134 158 patients during a medical check-up including routine blood analysis. Among these patients, 29 707 had transaminases and platelets counts available and benefited from an automatic calculation of FIB-4. Results were obtained from 21 French clinical laboratories in the Bouches du Rhône region.ResultsAmong the 29 707 patients, 2160 (7.3%) had significant fibrosis (FIB-4>2.67). Individual investigation of patients with FIB-4>2.67 allowed to screen 1267 (1267/2160: 59%) patients who were not managed for any liver disease.ConclusionsThis work demonstrates the interest of FIB-4 for the screening of liver fibrosis in primary care population. Our study strongly supports this easy-to-implement strategy using a simple Fib-4 measure resulting from the use of available routine test results.FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Clinical Registering NumberMR-0314071019 (INDS: French National Institute for Medical Data)

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Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months

BJGP Open ◽

10.3399/bjgpo.2021.0145 ◽

2021 ◽

pp. BJGPO.2021.0145

Author(s):

Tina Reinson ◽

Christopher D Byrne ◽

Janisha Patel ◽

Magdy El-Gohary ◽

Michael Moore

Keyword(s):

Primary Care ◽

Alcohol Consumption ◽

Liver Fibrosis ◽

Transient Elastography ◽

Lifestyle Changes ◽

Time Interval ◽

Patients At Risk ◽

Design Effectiveness ◽

B Uptake

BackgroundLiver fibrosis assessment services using transient elastography are growing in primary care. These services identify patients requiring specialist referral for liver fibrosis, and provide an opportunity for recommending lifestyle change. However, there are uncertainties regarding service design, effectiveness of advice given, and frequency of follow-up.AimsTo assess: a) effectiveness of standard care lifestyle advice for weight management and alcohol consumption; b) uptake for liver rescan; c) usefulness of a 4.5-year time interval of rescanning in monitoring progression of liver fibrosis.Design & settingAnalysis of patient outcomes 4.5 years after first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK.MethodOutcomes included weight, alcohol consumption, rescan uptake, time interval between scans and change in liver fibrosis stage.Results401 participants were re-contacted. Mean ± SD wt loss was 1.2 kg ±8.4 kg (P=0.005), alcohol AUDIT grade increased by 7.8% (P=<0.001). 116/401 participants were eligible for liver rescanning. 59/116 (50.9%) agreed to undergo rescanning. Mean ± SD time interval between scans was 53.6±3.4 months. Liver fibrosis progressed from mild (≥6.0 kPa-8.1kPa) to significant fibrosis (8.2 kPa-9.6kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7 kPa-13.5kPa)/cirrhosis (≥13.6 kPa) in 15.3% of patients, and did not progress in 81.3%. No baseline factors were independently associated with liver fibrosis progression at follow-up.ConclusionRescan recall attendance and adherence to lifestyle changes needs improving. Optimum time interval between scans remains uncertain. After a mean interval of 53.6 months between scans, and with no specific predictors indicated, a substantial minority (18.7%) experienced a deterioration in fibrosis grade.

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