Author information
1
Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Department of Gastroenterology, Alfred Health, and Monash University, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia. Electronic address: stephen.bloom@monash.edu.
2
Department of Gastroenterology, Alfred Health, and Monash University, Melbourne, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
3
Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
4
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
5
Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
6
Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
7
Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
8
Department of Gastroenterology, Western Health, Footscray, Victoria, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
9
Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; CATCH study group (Community Approach Targeting Cirrhosis and Hepatocellular carcinoma) , Australia.
Abstract
BACKGROUND:
As many as 70% of individuals with chronic hepatitis C (CHC) are managed solely in primary care. The aims of this study were to determine the prevalence of elevated liver stiffness measurement (LSM) in a cohort of community managed CHC patients and to evaluate predictors of advanced liver disease and liver related events.
METHODS:
A prospective cohort of adult CHC patients were recruited from 21 primary care practises throughout Victoria, Australia. Inclusion criteria included the presence of CHC for >6months, no recent (<18months) specialist input and no history of hepatocellular carcinoma. Clinical assessment, LSM and phlebotomy occurred in primary care. A hospital cohort was recruited for comparison. Participants were followed longitudinally and monitored for liver related events.
RESULTS:
Over 26 months, 780 community patients were recruited and included in the analysis. The median LSM was 6.9kPa in the community, with 16.5% at risk of advanced fibrosis (LSM≥12.5kPa); of these 8.5% had no laboratory features of advanced liver disease. The proportion at risk of cirrhosis was no different between the community and hospital cohorts (p=0.169). At-risk alcohol consumption, advancing age, elevated BMI and ALT were independent predictors of elevated LSM. Over a median follow-up of 15.2 months, liver related events occurred in 9.3% of those with an LSM≥12.5kPa. An LSM of 24 kPa had the highest predictive power for liver related events (HR 152 p<0.001).
CONCLUSION:
The prevalence of advanced fibrosis, as determined by LSM, in primary care managed CHC is significant and comparable to a hospital cohort. Furthermore, this study supports the use of LSM as a community screening tool in a CHC population and indicates a possible role in predicting liver related events.
LAY SUMMARY:
The prevalence of advanced liver disease in primary care managed Hepatitis C is unknown. Our data suggests that rates of advanced fibrosis in the community is significant (16.5%), often underdiagnosed and comparable to rates seen in specialist referral centres. Liver stiffness measurement is a feasible community screening tool prior to hepatitis C therapy and able to predict liver related adverse events.