TRANSIENT ELASTOGRAPHY IN COMMUNITY ALCOHOL SERVICES: CAN IT BE AN ADJUNCT AND IMPACT DRINKING BEHAVIOUR?

Introduction

Alcohol is the leading cause of cirrhosis in western populations. Early identification of high-risk drinkers followed by intervention is an effective way to reduce harm. We aim to assess the feasibility of integrating transient elastography (TE) into community alcohol services and to determine its impact on modifying drinking behaviours.

Method

A prospective cohort study was conducted at a community alcohol clinic in Nottingham (April-2012 to March-2014). Patients (>18years) with a primary alcohol problem were recruited. Those known to liver services or to have chronic liver disease were excluded. Significant liver fibrosis was defined by a liver stiffness measure (LSM) of >8 kilopascals (kPa). Follow-up was for a minimum of six months. Data were descriptively analysed for significant differences between patients with a normal LSM versus raised LSM.

Results

156 patients were invited; n=87 attended and n=86 underwent successful TE. The majority were male (n=53, 70.0%) and the mean age was 46.3 years (SD +/-9.8). Median liver stiffness was 6.9kPa. Clinically significant liver fibrosis was identified in n=33 (38.4%), of which n=6 were in cirrhotic range (≥15 kPa). Baseline median self-reported alcohol intake for normal stiffness was 126 units per week and in raised stiffness was 149.0 units per week the difference was non-significant (p=0.338). Median reduction in self-report alcohol intake in whole cohort was 65.0 units per week (p=<0.001), in normal liver stiffness group was 25.0 units per week (p=0.154), and in raised liver stiffness group was 78.5 units per week (p<0.001).

Conclusion

The study demonstrated that transient elastography is a feasible tool to stratify clinically significant liver disease in community alcohol services. It can stimulate a change in high-risk drinking behaviour and a normal liver stiffness result does not provide false reassurance to participants.