Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months

Abstract

BackgroundLiver 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.AimsTo 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 & settingAnalysis of patient outcomes 4.5 years after first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK.MethodOutcomes included weight, alcohol consumption, rescan uptake, time interval between scans and change in liver fibrosis stage.Results401 participants were re-contacted. Mean ± SD wt loss was 1.2 kg ±8.4 kg (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 (≥6.0 kPa-8.1kPa) to significant fibrosis (8.2 kPa-9.6kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7 kPa-13.5kPa)/cirrhosis (≥13.6 kPa) 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.ConclusionRescan 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.

Noninvasive serum biomarkers for liver fibrosis in NAFLD: current and future

“…25 26 Approximately 20% of patients diagnosed with low-levels of liver fibrosis (F1-F2) will progress to F3, or F4, within 5 years. 27 F2 is a stage of fibrosis that is easily managed in primary care and it is potentially treatable and maybe halted or reversed through lifestyle changes. 6 28 29 Alternatively, medications such as anti-fibrotic therapeutic drugs (currently in phase 3 trials 30 ) or GLP-1 agonist medication 31 may have beneficial effects on the early stages of liver fibrosis.…”

“…F2 fibrosis is a risk factor for cirrhosis and overall mortality and F2 increases the risk of extra hepatic complications including cardio vascular disease [ 22 , 23 ]. Approximately 20% of patients diagnosed with low-levels of liver fibrosis (F1–F2) will progress to F3, or F4, within 5 years [ 24 ]. F2 is a stage of fibrosis that is easily managed in primary care and it is potentially treatable and maybe halted or reversed through lifestyle changes [ 6 , 25 , 26 ].…”

Performance of the Enhanced Liver Fibrosis Score, Comparison with Vibration-controlled Transient Elastography Data, and Development of a Simple Algorithm to Predict Significant Liver Fibrosis in a Community-based Liver Service: A Retrospective Evaluation

“…7 We have shown recently that ∼20% of patients with a liver fibrosis stage of ≥F1 (≥6.0 kPa/low fibrosis) progressed to advanced fibrosis/cirrhosis during a 5 year period of follow-up. 8 Therefore the detection of liver fibrosis is important because it is a key risk factor for cirrhosis, hepatocellular carcinoma and end stage liver failure. 6,9 There are a growing number of liver fibrosis assessment services in primary care that use vibration-controlled transient elastography (VCTE) to identify patients who require specialist referral to hepatology services.…”

To scan or not to scan: Use of transient elastography in an integrated health system

“…Historically, liver biopsy was the gold standard for diagnosis of NAFLD[ 3 ]. However, advancements in non-invasive testing are beginning to change the standard, with safer, cost-effective[ 4 , 5 ], accurate[ 6 ] and readily accessible modalities[ 7 , 8 ] that can be utilized in the primary care setting[ 9 ]. In the United States, the most common modality is transient elastography, often delivered by the FibroScan device (Echosens, Paris, France).…”