Labenz, Arslanow and co-workers
aimed to evaluate the usefulness of a structured screening procedure in order to detect cirrhosis as early as possible. Participants in the German health check-up after the age of 35 were offered a questionnaire, liver function tests (AST and ALT), as well as a follow-up. In the presence of elevated levels of AST/ALT, the APRI score was calculated, and patients with a score >0.5 were referred to a liver expert in secondary and/or tertiary care. As a final result, 11,859 participants were enrolled, and available for final analysis. The control group consisted of 349,570 members undergoing regular check-up. The SEAL study found 488 individuals with elevated APRI scores (4.12%), and 45 cases of advanced fibrosis/cirrhosis. The standardised incidence of advanced fibrosis/cirrhosis in the screening programme was slightly higher than in controls (3.83‰ vs.
3.36‰). Thus, the comparison of the chance of fibrosis/cirrhosis diagnosis in SEAL vs
. in routine care was inconclusive. However, it has to be taken into account that when patients with decompensated cirrhosis at initial diagnosis were excluded from both cohorts in a post hoc
analysis, SEAL was associated with a 59% higher chance of early cirrhosis detection than routine care on average. Thus, the implementation of a structured screening programme may increase the rate of early detection of cirrhosis
in the general population.