Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma (CATCH) - Community Cirrhosis Prevalence in Viral Hepatitis
AASLD LiverLearning®. Bloom S. Nov 14, 2016; 144640
Topic: Health Care Delivery/Quality/Effectiveness
Dr. Stephen Bloom
Dr. Stephen Bloom

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TITLE: Community Approach Targeting Cirrhosis and Hepatocellular Carcinoma (CATCH) - Community Cirrhosis Prevalence in Viral Hepatitis

This study was not sponsored

The aim of this study was to estimate the prevalence of significant fibrosis and cirrhosis in an at-risk population in the community using transient elastography (TE) to measure liver stiffness (LSM).

Methods: Participants were recruited from 21 primary care centers across Melbourne, Australia. Inclusion criteria included age >18yrs, with hepatitis B (CHB) or hepatitis C (CHC) with duration >6months, absence of prior or recent (<18months) specialist input and no current or prior HCC. Clinical assessment and TE (Fibroscan® 402) were performed in primary care. LSMs of 8.0kPa and 12.5kPa were used as cut-offs for significant fibrosis (>F2) and cirrhosis (F4) respectively. The community cohort (c) was compared to a consecutively recruited hospital control group (h) from one tertiary center undergoing identical assessment.

Results: From October 2014 to April 2016, 752 community participants were assessed (498 cCHC / 253 cCHB). LSM failure occurred in one patient (0.13%) and phlebotomy failure in 6 (0.80%). TE was performed using the M probe in 95.5% (n=717) and the XL probe in 4.5% (n=34). The control cohort of 247 participants (179 hCHC/68 hCHB) only differed demographically by having an older median age in hCHC (p<0.001).

In the cCHC the mean LSM was 9.9kPa and in the cCHB it was 5.6kPa. There was no difference between mean LSM in the community and control cohorts (CHC p=0.773/CHB p=0.067). An LSM≥8kPa in the community was observed in 29.8% (41.8% cCHC/ 6.3% cCHB p<0.001) and a LSM≥12.5kpa seen in 9.9% (all cCHC-15.1%). Three cCHB patients were diagnosed as cirrhotic (1.2%) on clinical and radiological grounds (all LSM>11.0). This was at a lower prevalence than our hCHB (5.9% p=0.039). The distribution of LSM≥12.5kPa was no different between cCHC and hCHC (p=0.739).

On multivariate analysis; advanced age (OR 1.062 p<0.001), elevated BMI (OR 1.128 p=0.002), at risk (>140g/p.w.) alcohol consumption (OR 2.549 p=0.001) and genotype 6 (OR 8.347 p=0.009) were associated with an LSM≥12.5kPa in cCHC. In cCHB; elevated viral load (OR 2.063 p=0.023), BMI (OR1.518 p=0.019) and viral phase 2 (OR 21.818 p=0.033) were associated with increased risk of cirrhosis however were not significant on multivariate analysis.

Conclusion: This study demonstrates that a community-based screening program using LSM is practical with an acceptable uptake in the CHC and CHB population. Based on the LSM data, the prevalence of fibrosis and cirrhosis in the community CHC patients is significant and comparable to that seen in a tertiary hospital cohort. These results have considerable importance with respect to allocation of healthcare resources.
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