Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months

BJGP Open

Janisha Patel¹  Magdy El-Gohary²  Christopher D Byrne³  Michael Moore⁴  Tina Reinson⁵ 

[1] Consultant Hepatologist, Department of Gastroenterology and Hepatology, University Hospital Southampton, Southampton, UK;GP, Shirley Health Partnership, Southampton, UK;Professor of Endocrinology and Metabolism, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK;Professor of Primary Health Care Research, Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK;Researcher, Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK;

关键词: primary healthcare;    mass screening;    early diagnosis;    risk reduction behaviour;    liver diseases;    general practice;   

DOI  :  10.3399/BJGPO.2021.0145

来源: DOAJ

【 摘 要 】

Background: Liver fibrosis assessment services using transient elastography are growing in primary care. These services identify patients requiring specialist referral for liver fibrosis, and provide an opportunity for recommending lifestyle change. However, there are uncertainties regarding service design, effectiveness of advice given, and frequency of follow-up. Aim: To assess the following: (a) effectiveness of standard care lifestyle advice for weight management and alcohol consumption; (b) uptake for liver rescan; and (c) usefulness of a 4.5-year time interval of rescanning in monitoring progression of liver fibrosis. Design & setting: Analysis of patient outcomes 4.5 years after the first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK. Method: Outcomes included weight, alcohol consumption, rescan uptake, time interval between scans, and change in liver fibrosis stage. Results: A total of 401 participants were recontacted. Mean standard deviation (± SD) weight loss was 1.2 kg±8.4 kg (P = 0.005); Alcohol Use Disorders Identification Test (AUDIT) grade increased by 7.8% (P ≤0.001). A total of n = 116/401 participants were eligible for liver rescanning and n = 59/116 (50.9%) agreed to undergo rescanning. Mean ± SD time interval between scans was 53.6±3.4 months. Liver fibrosis progressed from mild (≥6.0 kPa–8.1 kPa) to significant fibrosis (8.2 kPa–9.6 kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7 kPa–13.5 kPa) and cirrhosis (≥13.6 kPa) in 15.3% of patients, and did not progress in 81.3%. No baseline factors were independently associated with liver fibrosis progression at follow-up. Conclusion: Rescan recall attendance and adherence to lifestyle changes needs improving. Optimum time interval between scans remains uncertain. After a mean interval of 53.6 months between scans, and with no specific predictors indicated, a substantial minority (18.7%) experienced a deterioration in fibrosis grade.

【 授权许可】

Unknown