Liver fibrosis screening increases alcohol abstinence

Abstract

Background & Aimsindividuals with alcohol use disorder (AUD) are at risk of liver disease. There is scarce information on the effectiveness of screening for liver fibrosis with alcohol consumption. We evaluated the efficacy of a screening program for liver fibrosis on alcohol consumption in subjects with AUD. Methodsprospective interventional study performed in the Hospital Clinic of Barcelona. The screening cohort included subjects with AUD from the Addiction Unit that underwent screening for liver fibrosis with transient elastography and counselling on lifestyle habits in the Liver Unit. The control cohort included subjects with similar characteristics visited in the same unit in a previous period, that did not undergo the screening. Effects on alcohol consumption were evaluated at six months, after clinical follow-up, with clinical assessment by addiction specialists and urine ethylglucuronide (uETG) monitoring. ResultsIn the screening cohort, 149/334 (45%) subjects were abstinent at six months (68% confirmed with uETG). Alcohol abstinence was higher in the screening cohort than in the control cohort (40/137 subjects, 29%, p=.002). Factors associated with alcohol abstinence in the multivariate analysis of the two combined cohorts (n=471) were: receiving AUD medications (OR 1,72, CI: 1.11-2.67), absence of illicit drugs use (OR .50, CI: .31-.80) and participating in the screening program (OR 1.77, CI: 1.14-2.74). In the screening cohort, 40 (12%) subjects had increased liver stiffness (LSM≥8 kPa); obesity (p=.03), arterial hypertension (p=.03), GGT (p<.001) and platelets levels (p=.001) were associated with increased LSM. Conclusionsthis study shows that an integrated screening program for liver fibrosis associated with counselling on alcohol consumption in subjects with AUD allows early diagnosis of alcohol-associated liver disease and is associated with alcohol abstinence. Impact and implicationsIndividuals with high alcohol consumption are at higher risk of liver disease compared to the general population. The potential beneficial effects of screening for liver disease in this population have scarcely been studied. We show that a screening program for liver fibrosis together with lifestyle counselling intervention favoured alcohol abstinence among subjects with alcohol use disorder attending an Addiction Unit at six months, as compared to a matched cohort who did not undergo screening. These findings suggest that screening programs for liver fibrosis have a therapeutic role in subjects with alcohol use disorder and encourage the implementation of these programs in Addiction Units.