High Prevalence of Liver Fibrosis Among European Adults with Unknown Liver Disease. A Population-Based Study

2018 Clinical Gastroenterology & Hepatology In Press;

BACKGROUND AND AIMS: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about prevalence of liver fibrosis in general population. Aim of the study was to investigate the prevalence of liver fibrosis in general adult population with unknown liver disease. METHODS: Population-based, cross-sectional study, performed in Barcelona metropolitan area. Subjects aged 18-75yr were identified randomly from citizens included in primary health care registry. Out of 4,866 subjects invited, 3,076 accepted to participate (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (>/=6.8, >/=8.0, and >/=9.0kPa) were 9.0%, 5.8%, and 3.6%, respectively. Etiology of liver disease was mainly NAFLD, followed by alcohol risk consumption. Factors independently associated with increased LS were male gender, abdominal obesity, type-2 diabetes, serum glucose, HDL, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had very low prevalence of increased LS. The best cutoff of LS for significant liver fibrosis (F2-F4) was 9.2kPa, with high sensitivity and specificity. TE was more accurate than ALT, NAFLD fibrosis score or FIB-4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings demonstrate a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. A value of LS