Highlights
- •The rate of advanced fibrosis in community hepatitis C is significant at 16.5%.
- •No laboratory features of active disease were seen in 8.5% at risk of cirrhosis.
- •Rates of advanced fibrosis were comparable between a hospital and community groups.
- •Older age, high BMI, ALT and alcohol use were linked to elevated liver stiffness.
- •A liver stiffness greater than 24 kPa predicted liver related events in this cohort.
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 ratio 152; 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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 27, 2018
Accepted:
April 13,
2018
Received in revised form:
April 12,
2018
Received:
September 26,
2017
See Editorial, pages 562–563Identification
Copyright
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
