Alcohol-Associated Liver Disease: Evolving Concepts and Treatments

Prince, David Stephen; Nash, Emily; Liu, Ken

doi:10.1007/s40265-023-01939-9

Cited by 11 publications

(1 citation statement)

References 125 publications

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“…Alcohol intake was qualified in standard drinks per week (with 1 standard drink defined at 10 g of ethanol). [18] TE was conducted using the standard approach to obtain a liver stiffness measurement (LSM) using the appropriate probe type for each patient (either M or XL). TE assessments required a minimum of 10 measurements with a success rate of ≥ 60% and an IQR of ≤ 30% (if LSM ≥ 7) were deemed valid.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Prince,

Hoque,

Kim

et al. 2024

Hepatology Communications

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Background: Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression. Methods: A cloud-based software solution (“the Liver Toolkit”) was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded. Results: Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0–9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction–associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041). Conclusions: This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.

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Section: Clinical Assessmentmentioning

confidence: 99%