Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months
Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months
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.
Aims To assess: a) effectiveness of standard care lifestyle advice for weight management and alcohol consumption; b) uptake for liver rescan; c) usefulness of a 4.5-year time interval of rescanning in monitoring progression of liver fibrosis.
Design and setting Analysis of patient outcomes 4.5 years after first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK.
Methods Outcomes included weight, alcohol consumption, rescan uptake, time interval between scans and change in liver fibrosis stage.
Results 401 participants were re-contacted. Mean±SD weight loss was 1.2kg±8.4kg (p=0.005), alcohol AUDIT grade increased by 7.8% (p=<0.001). 116/401 participants were eligible for liver rescanning. 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 (≥6.0kPa-8.1kPa) to significant fibrosis (8.2kPa-9.6kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7kPa-13.5kPa)/cirrhosis (≥13.6kPa) 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.
Primary care, screening, early diagnosis, risk reduction behaviour, liver disease
Reinson, Tina
929fcf68-3a7d-42e4-9efd-e9d188b2b9c8
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Patel, Janisha
b3f5e48c-b24f-4480-b1e4-5e726a4e78c5
El-Gohary, Magdy
2cce8096-1b14-4772-bc94-884289b9fdbe
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
27 September 2021
Reinson, Tina
929fcf68-3a7d-42e4-9efd-e9d188b2b9c8
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Patel, Janisha
b3f5e48c-b24f-4480-b1e4-5e726a4e78c5
El-Gohary, Magdy
2cce8096-1b14-4772-bc94-884289b9fdbe
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Reinson, Tina, Byrne, Christopher, Patel, Janisha, El-Gohary, Magdy and Moore, Michael
(2021)
Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months.
BJGP Open, [BJGPO-2021-0145.R1].
(doi:10.3399/BJGPO.2021.0145).
Abstract
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.
Aims To assess: a) effectiveness of standard care lifestyle advice for weight management and alcohol consumption; b) uptake for liver rescan; c) usefulness of a 4.5-year time interval of rescanning in monitoring progression of liver fibrosis.
Design and setting Analysis of patient outcomes 4.5 years after first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK.
Methods Outcomes included weight, alcohol consumption, rescan uptake, time interval between scans and change in liver fibrosis stage.
Results 401 participants were re-contacted. Mean±SD weight loss was 1.2kg±8.4kg (p=0.005), alcohol AUDIT grade increased by 7.8% (p=<0.001). 116/401 participants were eligible for liver rescanning. 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 (≥6.0kPa-8.1kPa) to significant fibrosis (8.2kPa-9.6kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7kPa-13.5kPa)/cirrhosis (≥13.6kPa) 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.
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More information
Accepted/In Press date: 17 September 2021
e-pub ahead of print date: 27 September 2021
Published date: 27 September 2021
Additional Information:
Funding
This research was funded by the British Liver Trust and Solent NHS Trust. CDB is supported in part by the Southampton NIHR Biomedical Research Centre (IS-BRC-20004), UK).
Ethical approval
This study was reviewed and approved by NRES Committee South Central—Hampshire A, Bristol Research Ethics Committee Centre, level 3, block B, Whitefriars, Lewins Mead Bristol BS1 2NT.
Trial registration number
Trial registration number: 13/SC/0012; post-results. LOCATE - LOcal Care And Treatment Evaluation (ISRCTN 03563761)
Keywords:
Primary care, screening, early diagnosis, risk reduction behaviour, liver disease
Identifiers
Local EPrints ID: 451629
URI: http://eprints.soton.ac.uk/id/eprint/451629
PURE UUID: 9ee17d28-ba0a-4a06-b44b-66a1184e1545
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Date deposited: 15 Oct 2021 16:31
Last modified: 17 Mar 2024 04:04
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Contributors
Author:
Tina Reinson
Author:
Janisha Patel
Author:
Magdy El-Gohary
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