Stephen Bloom1, William Kemp2, Amanda Nicoll3, Stuart K Roberts2, Paul Gow4, Anouk Dev5, Sally Bell6, Siddharth Sood7, Ian Kronborg8, Virginia Knight5, Diana Lewis9, John Lubel9. 1. Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Department of Gastroenterology, Alfred Health, and Monash University, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. Electronic address: stephen.bloom@monash.edu. 2. Department of Gastroenterology, Alfred Health, and Monash University, Melbourne, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 3. Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 4. Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 5. Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 6. Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 7. Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 8. Department of Gastroenterology, Western Health, Footscray, Victoria, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia. 9. Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH Study Group (Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma), Australia.
Abstract
BACKGROUND & AIMS: As many as 70% of individuals with chronic hepatitis C (CHC) are managed solely in primary care. The aims of this study were to determine the prevalence of elevated liver stiffness measurement (LSM) in a cohort of community managed patients with CHC and to evaluate predictors of advanced liver disease and liver-related events. METHODS: A prospective cohort of adult patients with CHC were recruited from 21 primary care practices throughout Victoria, Australia. Inclusion criteria included the presence of CHC for >6 months, no recent (<18 months) specialist input and no history of hepatocellular carcinoma. Clinical assessment, LSM and phlebotomy were carried out in primary care. A hospital cohort was recruited for comparison. Participants were followed longitudinally and monitored for liver-related events. RESULTS: Over 26 months, 780 community patients were recruited and included in the analysis. The median LSM was 6.9 kPa in the community, with 16.5% of patients at risk of advanced fibrosis (LSM ≥12.5 kPa); of these 8.5% had no laboratory features of advanced liver disease. The proportion at risk of cirrhosis was no different between the community and hospital cohorts (p = 0.169). At-risk alcohol consumption, advancing age, elevated body mass index and alanine aminotransferase were independent predictors of elevated LSM. Over a median follow-up of 15.2 months, liver-related events occurred in 9.3% of those with an LSM ≥12.5 kPa. An LSM of 24 kPa had the highest predictive power for liver-related events (hazard ratio152; p <0.001). CONCLUSION: The prevalence of advanced fibrosis, as determined by LSM, in primary care managed CHC is significant and comparable to a hospital cohort. Furthermore, this study supports the use of LSM as a community screening tool in a CHC population and indicates a possible role in predicting liver-related events. LAY SUMMARY: The prevalence of advanced liver disease in primary care managed hepatitis C is unknown. Our data suggests that rates of advanced fibrosis in the community are significant (16.5%), often underdiagnosed and comparable to rates seen in specialist referral centres. Liver stiffness measurement is a feasible community screening tool prior to hepatitis C therapy and can predict liver-related adverse events.
BACKGROUND & AIMS: As many as 70% of individuals with chronic hepatitis C (CHC) are managed solely in primary care. The aims of this study were to determine the prevalence of elevated liver stiffness measurement (LSM) in a cohort of community managed patients with CHC and to evaluate predictors of advanced liver disease and liver-related events. METHODS: A prospective cohort of adult patients with CHC were recruited from 21 primary care practices throughout Victoria, Australia. Inclusion criteria included the presence of CHC for >6 months, no recent (<18 months) specialist input and no history of hepatocellular carcinoma. Clinical assessment, LSM and phlebotomy were carried out in primary care. A hospital cohort was recruited for comparison. Participants were followed longitudinally and monitored for liver-related events. RESULTS: Over 26 months, 780 community patients were recruited and included in the analysis. The median LSM was 6.9 kPa in the community, with 16.5% of patients at risk of advanced fibrosis (LSM ≥12.5 kPa); of these 8.5% had no laboratory features of advanced liver disease. The proportion at risk of cirrhosis was no different between the community and hospital cohorts (p = 0.169). At-risk alcohol consumption, advancing age, elevated body mass index and alanine aminotransferase were independent predictors of elevated LSM. Over a median follow-up of 15.2 months, liver-related events occurred in 9.3% of those with an LSM ≥12.5 kPa. An LSM of 24 kPa had the highest predictive power for liver-related events (hazard ratio152; p <0.001). CONCLUSION: The prevalence of advanced fibrosis, as determined by LSM, in primary care managed CHC is significant and comparable to a hospital cohort. Furthermore, this study supports the use of LSM as a community screening tool in a CHC population and indicates a possible role in predicting liver-related events. LAY SUMMARY: The prevalence of advanced liver disease in primary care managed hepatitis C is unknown. Our data suggests that rates of advanced fibrosis in the community are significant (16.5%), often underdiagnosed and comparable to rates seen in specialist referral centres. Liver stiffness measurement is a feasible community screening tool prior to hepatitis C therapy and can predict liver-related adverse events.
Authors: Christopher R Bradley; Eleanor F Cox; Naaventhan Palaniyappan; Susan T Francis; Indra Neil Guha; Guruprasad P Aithal Journal: Eur Radiol Exp Date: 2022-10-24
Authors: Xavier Forns; Jordan J Feld; Douglas E Dylla; Stanislas Pol; Kazuaki Chayama; Jinlin Hou; Jeong Heo; Pietro Lampertico; Ashley Brown; Mark Bondin; Fernando Tatsch; Margaret Burroughs; John Marcinak; Zhenzhen Zhang; Amanda Emmett; Stuart C Gordon; Ira M Jacobson Journal: Adv Ther Date: 2021-05-22 Impact factor: 3.845
Authors: Paul J Clark; Patricia C Valery; James Ward; Simone I Strasser; Martin Weltman; Alexander Thompson; Miriam T Levy; Barbara Leggett; Amany Zekry; Julian Rong; Peter Angus; Jacob George; Steven Bollipo; Bruce McGarity; William Sievert; Gerry Macquillan; Edmund Tse; Amanda Nicoll; Amanda Wade; Geoff Chu; Damian Harding; Wendy Cheng; Geoff Farrell; Stuart K Roberts Journal: BMC Gastroenterol Date: 2022-07-11 Impact factor: 2.847