Abstract
Background and aimsAlcohol use disorders (AUD) cause 7.2% of UK hospital admissions/year. Most are not managed by hepatologists and liver disease may be missed. We used the Enhanced Liver Fibrosis (ELF) test to investigate prevalence and associations of occult advanced liver fibrosis in AUD patients not known to have liver fibrosis.MethodsLiver fibrosis was assessed using ELF in prospective patients referred to the Royal Free Hospital Alcohol Specialist Nurse (November 2018–December 2019). Known cases of liver disease were excluded. Patient demographics, blood tests, imaging data and alcohol histories recorded. Advanced fibrosis was categorised as ELF ≥ 10.5.ResultsThe study included 99 patients (69% male, mean age 53.1 ± 14.4) with median alcohol intake 140 units/week (IQR 80.9–280), and a mean duration of harmful drinking of 15 years (IQR 10–27.5). The commonest reason for admission was symptomatic alcohol withdrawal (36%). The median ELF score was 9.62, range 6.87–13.78. An ELF score ≥ 10.5 was recorded in 28/99 (29%) patients, of whom 28.6% had normal liver tests. Within previous 5-years, 76% had attended A&E without assessment of liver disease. The ELF score was not associated with recent alcohol intake (p = 0.081), or inflammation (p = 0.574).ConclusionOver a quarter of patients with AUD had previously undetected advanced liver fibrosis assessed by ELF testing. ELF was not associated with liver inflammation or recent alcohol intake. The majority had recent missed opportunities for investigating liver disease. We recommend clinicians use non-invasive tests to assess liver fibrosis in patients admitted to hospital with AUD.
Highlights
Background and aimsAlcohol use disorders (AUD) cause 7.2% of UK hospital admissions/year
Enhanced Liver Fibrosis (ELF) score was not associated with inflammation (AST or Alanine aminotransferase (ALT))
ELF score was not associated with amount of alcohol consumed (Units/Week)
Summary
Background and aimsAlcohol use disorders (AUD) cause 7.2% of UK hospital admissions/year. Hospital admissions related to alcohol are rising annually, with 350,000 alcohol related admissions per year in 2019, (an increase of 20% in a decade) [3] and with a cost to the NHS of £3.5 billion per year [4] This is likely to be due to a shift in drinking behaviours from low-strength beer in pubs to home consumption of higher strength beer, wine and spirits sold in supermarkets. While a proportion of people admitted to hospital with harms arising from their drinking behaviour are recognised to have liver fibrosis and are managed by liver specialists, many are managed by a wide range of doctors and their liver disease may be missed, even if their alcohol use disorder (AUD) is recognised
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