期刊
BMJ OPEN
卷 5, 期 4, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2014-007516
关键词
-
资金
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, part of the University of Nottingham
- Nottingham University Hospitals NHS Trust
- University of Nottingham
- National Institute for Health Research (NIHR)
Objectives: To assess the feasibility of a novel diagnostic algorithm targeting patients with risk factors for chronic liver disease in a community setting. Design: Prospective cross-sectional study. Setting: Two primary care practices (adult patient population 10 479) in Nottingham, UK. Participants: Adult patients (aged 18 years or over) fulfilling one or more selected risk factors for developing chronic liver disease: (1) hazardous alcohol use, (2) type 2 diabetes or (3) persistently elevated alanine aminotransferase (ALT) liver function enzyme with negative serology. Interventions: A serial biomarker algorithm, using a simple blood-based marker (aspartate aminotransferase: ALT ratio for hazardous alcohol users, BARD score for other risk groups) and subsequently liver stiffness measurement using transient elastography (TE). Main outcome measures: Diagnosis of clinically significant liver disease (defined as liver stiffness >= 8 kPa); definitive diagnosis of liver cirrhosis. Results: We identified 920 patients with the defined risk factors of whom 504 patients agreed to undergo investigation. A normal blood biomarker was found in 62 patients (12.3%) who required no further investigation. Subsequently, 378 patients agreed to undergo TE, of whom 98 (26.8% of valid scans) had elevated liver stiffness. Importantly, 71/98 (72.4%) patients with elevated liver stiffness had normal liver enzymes and would be missed by traditional investigation algorithms. We identified 11 new patients with definite cirrhosis, representing a 140% increase in the number of diagnosed cases in this population. Conclusions: A non-invasive liver investigation algorithm based in a community setting is feasible to implement. Targeting risk factors using a non-invasive biomarker approach identified a substantial number of patients with previously undetected cirrhosis.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据