Introduction Liver deaths have increased 5–8 fold in 30 years and the majority are alcohol related. Cirrhosis develops silently and presents late; around 25% of subjects die before they have a chance to stop drinking. Blood tests in routine use do not stage fibrosis and diagnosis often requires a liver biopsy—impractical for the 2 million UK residents drinking at levels that may result in cirrhosis. Newer blood tests detect cirrhosis and progressive fibrosis at an earlier stage and, combined with alcohol screening, could greatly improve detection and management of these patients, reducing morbidity and mortality.
Aim Assess feasibility of screening a primary care population for hazardous drinking using the AUDIT questionnaire, practicality of screening heavy alcohol users for liver disease using a non-invasive test and resource implications of assessment and follow-up.
Method We offered postal screening to 10 000 adults age 25–55 randomly selected from general practice lists using the AUDIT questionnaire. An offer of liver fibrosis tests was made to those screening positive. Those with marked elevation of fibrosis markers are referred on for liver health checks markers. Participants were followed up after 1 year.
Results 10 000 AUDITs were dispatched from 9 primary care sites. Response rate was 3677 (37%) Of these responders 907 were hazardous/harmful drinkers (18.5%), of whom 207 (4.2%) were dependent drinkers. Audit positive subjects were invited to attend a research clinic of whom 290 (32%) attended and were screened using our traffic light algorithm (HA, P3NP, PTS, albumin, INR) of whom 28 (9.6%) were red (cirrhosis/severe fibrosis) and 121 (41%) amber (50% likelihood of progressive fibrosis in a secondary care population).
Conclusion Postal screening for hazardous drinking followed by non-invasive liver assessment is feasible in the primary care setting. Ten percent of hazardous drinkers had good evidence of significant liver disease and a half had equivocal serum fibrosis markers, with these results fed back to subjects to encourage behaviour change. Further details and follow-up results will be available.
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