Outreach screening of drug users for cirrhosis with transient elastography
Version of Record online: 23 DEC 2010
© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction
Volume 106, Issue 5, pages 970–976, May 2011
How to Cite
Moessner, B. K., Jørgensen, T. R., Skamling, M., Vyberg, M., Junker, P., Pedersen, C. and Christensen, P. B. (2011), Outreach screening of drug users for cirrhosis with transient elastography. Addiction, 106: 970–976. doi: 10.1111/j.1360-0443.2010.03246.x
- Issue online: 8 APR 2011
- Version of Record online: 23 DEC 2010
- Accepted manuscript online: 21 OCT 2010 07:45AM EST
- Submitted 20 April 2010; initial review completed 26 May 2010; final version accepted 11 October 2010
Vol. 107, Issue 1, 236, Version of Record online: 12 DEC 2011
- hepatitis C;
- hyaluronic acid;
- transient elastography
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 < 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (<12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 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.