Community screening for cirrhosis using liver stiffness measurement-a pilot study.

The prevalence of cirrhosis in the Australian community is unknown. Moreover, as only 1-2% of patients with chronic hepatitis B (CHB) and C (CHC) are receiving active specialist assessment,(1,2) there is an urgent need to detect those in the community at high risk of liver related morbidity and mortality. Fibroscan liver stiffness measurement (LSM) is a simple safe and increasingly accepted non-invasive method of assessing liver disease severity. This study aims to determine the feasibility of community screening and estimate the prevalence of significant fibrosis and cirrhosis as assessed by non-invasive techniques in at-risk populations. Method(s): Participants were consecutively recruited from 14 primary care practices with high case-loads of CHB and CHC throughout Melbourne, Australia. Inclusion criteria included age 18-80 years, with evidence of infection duration >6 months, absence of prior or recent (<18 months) specialist input and no current or prior HCC, or pregnancy. Clinical assessment, transient elastography (Fibroscan 402) and blood analysis were performed at their place of primary care. AST to platelet ratio index (APRI) and Fibrosis-4 (FIB4) scores were calculated for comparison with LSM. Scans were considered reliable if the success rate was >60% and IQR/median stiffness < 0.3. A control primary hospital presentation cohort was recruited to assess for selection bias. LSMs of 8 kPa and 13 kPa were taken as cut-offs to represent a high probability of significant fibrosis (>F2) and cirrhosis (F4) respectively. Individuals meeting these cut-offs were referred to nearby tertiary centers for ongoing management. Result(s): A total of 238 patients were recruited during a pilot phase of 5 months. Of these, 160 were CHC and 78 were CHB. There was a 31.4% failure to attend rate in the community cohort. Fibroscan LSM was successfully obtained in all patients with four (1.6%) requiring use of the XL-probe. The community cohort was predominantly male (CHC 73.1% v