Abstract
Introduction: Alcohol is the leading cause of cirrhosis in Western populations. The early identification of high-risk drinkers followed by intervention is an effective way to reduce harm. We aim to assess the feasibility of integrating transient elastography (TE) into community alcohol services, and to determine its impact on modifying drinking behaviours. Method: A prospective cohort study was conducted at a community alcohol clinic in Nottingham, UK (April 2012 to March 2014). Patients (>18 years) with a primary alcohol problem were recruited. Those known to liver services or those known to have chronic liver disease were excluded. Significant liver fibrosis was defined by a liver stiffness of >8 kilopascal (kPa). Follow-up was for a minimum of six months. Data were descriptively analysed for significant differences between patients with a normal liver stiffness versus raised liver stiffness. Results: 156 patients were invited; n = 87 attended and n = 86 underwent successful TE. The majority were male (n = 53, 70.0%), and the mean age was 46.3 years (SD ± 9.8). Median liver stiffness was 6.9 kPa (range 3.1–75.0kPa). Clinically significant liver fibrosis was identified in n = 33 (38.4%), of which n = 6 were in the cirrhotic range (≥15 kPa). The baseline median self-reported alcohol intake for normal stiffness was 126 units per week (range 24–378) and in raised stiffness was 149.0 units per week (range 39.0–420.0); this difference was nonsignificant (p = 0.338). The median reduction in self-reported alcohol intake in the whole cohort was 65.0 units per week (range 27.0–88.0, p < 0.001); in the normal liver stiffness group it was 25.0 units per week (range 18.0–75.0, p = 0.154), and in the raised liver stiffness group it was 78.5 units per week (range 36.0–126.0, p < 0.001). Conclusion: The study demonstrated that transient elastography is a feasible tool to stratify clinically significant liver disease in community alcohol services. It can stimulate a change in high-risk drinking behaviour and a normal liver stiffness result does not provide false reassurance to participants.
Highlights
Alcohol is the leading cause of cirrhosis in Western populations
Liver disease causes no symptoms in its earlier stages; over half of patients have liver disease first diagnosed after an emergency hospital admission at a stage when the scope of any medical or behavioural intervention is minimal [1,2,11]
A total of n = 156 patients who consecutively presented to Oxford Corner Alcohol
Summary
Alcohol is the leading cause of cirrhosis in Western populations. The early identification of high-risk drinkers followed by intervention is an effective way to reduce harm.We aim to assess the feasibility of integrating transient elastography (TE) into community alcohol services, and to determine its impact on modifying drinking behaviours. Patients (>18 years) with a primary alcohol problem were recruited Those known to liver services or those known to have chronic liver disease were excluded. Over the last three decades, the UK has observed a 400% rise in liver-disease-related mortality, and in 2020, Public Health England reported that alcohol-specific deaths had reached their highest level since 2001 [1,4,5]. Liver disease causes no symptoms in its earlier stages; over half of patients have liver disease first diagnosed after an emergency hospital admission at a stage when the scope of any medical or behavioural intervention is minimal [1,2,11]. Once patients with alcohol misuse develop cirrhosis, the prognosis becomes exceptionally poor; the mortality rate for alcohol-related cirrhosis has been reported as high as 75% at 5 years and 91% at 15 years [13]
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