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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
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
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).

Record type: Article

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
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
ORCID for Tina Reinson: ORCID iD orcid.org/0000-0002-2436-1906
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 15 Oct 2021 16:31
Last modified: 13 Dec 2021 03:40

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Contributors

Author: Tina Reinson ORCID iD
Author: Janisha Patel
Author: Magdy El-Gohary
Author: Michael Moore ORCID iD

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