Outreach screening of drug users for cirrhosis with transient elastography

2011 Addiction 106;5 (970-976)

AIMS: Transient elastography (TE) is a non-invasive sensitive tool for diagnosing cirrhosis in hospital-based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. DESIGN: Cross-sectional study. SETTING: All treatment centres in the county of Funen, Denmark. PARTICIPANTS: Drug users attending treatment centres during the presence of the study team. MEASUREMENTS: Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM >/= 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM >/= 12 kPa were recommended a liver biopsy. FINDINGS: Among 175 drug users negative for hepatitis C, 13% had LSM = 8-11.9 kPa and 4% had LSM >/= 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8-11.9 kPa and 21.1% had LSM >/= 12 kPa (P /= 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. CONCLUSIONS: Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.

Pubmed : 21182552