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Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years
  1. Dominique Roulot1,2,
  2. Jean-Luc Costes3,
  3. Jean-François Buyck4,
  4. Ursula Warzocha1,
  5. Nicolas Gambier1,
  6. Sébastien Czernichow4,5,
  7. Hervé Le Clesiau3,
  8. Michel Beaugrand2
  1. 1Unité d'Hépatologie, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Bobigny and UPRES-EA 3406, Université Paris 13, Bobigny, France
  2. 2Service d'Hépatogastroenterologie, Hôpital Jean Verdier, Assistance Publique, Hôpitaux de Paris, Bondy and Université Paris 13, Bobigny, France
  3. 3Centre de Prévention Sanitaire et Sociale, Bobigny, France
  4. 4Département de Santé Publique, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Bobigny, France
  5. 5INSERM, U55; INRA, U1125; CNAM, EA3200; CRNH-IdF, Université Paris 13, Bobigny, France
  1. Correspondence to Dominique Roulot, Unité d' Hépatologie, Hopital Avicenne, 125 route de Stalingrad 93009 Bobigny, France; dominique.roulot{at}avc.aphp.fr

Abstract

Background Liver stiffness measurement (LSM) has been used to measure fibrosis in patients with various types of chronic liver diseases. However, its usefulness as a screening procedure in apparently healthy people had not been evaluated to date.

Methods 1358 subjects >45 years old from a general population attending for a medical check-up were consecutively enrolled in the study. All subjects were submitted to medical examination and laboratory tests in addition to LSM, performed on the same day by a single operator. Subjects with LSM values >8 kPa were referred to a liver unit for further investigations.

Results 168 subjects were not considered for analysis due to missing data (n=23), LSM failure (n=51) or unreliable LSM values (n=94). Among the 1190 remaining subjects, 89 (7.5%) had LSM >8 kPa including nine patients with LSM >13 kPa. Despite the fact that normal liver tests were observed in 43% of them (38 out of 89), a specific cause of chronic liver disease was found in all cases. Non-alcoholic fatty liver disease (NAFLD) was the likely cause of chronic liver disease in 52 patients, alcoholic liver disease (ALD) in 20, and both causes were associated in seven additional patients. Hepatitis C virus and hepatitis B virus chronic hepatitis was documented in five and four cases, respectively, and primary biliary cirrhosis in one. Liver biopsy was obtained for 27 patients, including the nine patients with LSM >13 kPa, who were diagnosed with liver cirrhosis due to ALD (n=5), chronic hepatitis C (n=3) or chronic hepatitis B (n=1). The 18 remaining biopsies showed liver fibrosis in all cases except one (isolated steatosis), with ALD and NAFLD being present in six and eight cases, respectively.

Conclusion LSM proved to be a useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.

  • Fibroscan
  • liver stiffness
  • screening procedure
  • non alcoholic fatty liver disease
  • metabolic syndrome
  • cirrhosis
  • fibrosis
  • liver biopsy
  • nonalcoholic steatohepatitis

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Footnotes

  • See Commentary, p 883

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the CCPPRB, Aulnay-sous-Bois, France.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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