Llorenç Caballería1, Guillem Pera1, Ingrid Arteaga2, Lluís Rodríguez1, Alba Alumà3, Rosa Ma Morillas4, Napoleón de la Ossa5, Alba Díaz6, Carmen Expósito2, Dolores Miranda7, Carmen Sánchez8, Rosa Ma Prats8, Marta Urquizu2, Angels Salgado2, Magda Alemany2, Alba Martinez2, Irfan Majeed2, Núria Fabrellas9, Isabel Graupera10, Ramón Planas4, Isabel Ojanguren5, Miquel Serra11, Pere Torán1, Juan Caballería10, Pere Ginès12. 1. Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain. 2. Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció, Primària Jordi Gol, Mataró, Barcelona, Spain. 3. Biochemistry Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain. 4. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Hepatology Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain. 5. Pathological Department, Hospital Germans Triasi Pujol, Badalona, Barcelona, Spain. 6. Pathological Department, Hospital Clínic, Barcelona, Spain. 7. Radiology Department, Institut Català de la Salut, Mataró, Barcelona, Spain. 8. Radiology Department, Institut Català de la Salut, Santa Coloma Gramenet, Barcelona, Spain. 9. School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. 10. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Liver Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain. 11. Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Catalonia. 12. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Liver Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain. Electronic address: pgines@clinic.cat.
Abstract
BACKGROUND & AIMS: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.
BACKGROUND & AIMS:Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.
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