University of Sussex
Browse
- No file added yet -

Chronic liver disease in homeless individuals and performance of non-invasive liver fibrosis and injury markers: VALID study

Download (504.56 kB)
journal contribution
posted on 2023-06-10, 01:55 authored by Ahmed Hashim, Stephen BremnerStephen Bremner, Jane I Grove, Stuart Astbury, Manuela MengozziManuela Mengozzi, Margaret O'Sullivan, Lucia MackenLucia Macken, Tim Worthley, Dev Katarey, Guruprasad P Aithal, Sumita VermaSumita Verma
Background/aims Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remains poorly described. We aimed to determine prevalence/predictors of chronic liver disease (CLD) in PWAH and assess performance of non-invasive hepatocyte fibrosis and injury markers. Methods The Vulnerable Adult LIver Disease (VALID) study provided a “one-stop” liver service based at homeless hostels. Our primary outcome was the prevalence of clinically significant hepatic fibrosis (CSHF) (liver stiffness measurement (LSM) = 8kPa). Results Total individuals recruited were 127, mean±SD age 47±9.4 years, 50% (95% CI 41%-59%) and 39% (95% CI 31%- 48%) having alcohol dependence and a positive HCV RNA respectively. CSHF was detected in 26% (95% CI 17%-35%), independent predictors being total alcohol unit/week (OR 1.01, 95% CI 1.00-1.02, p=0.002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, p=0.029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, p<0.001) for CSHF as assessed by LSM =8kPa. Those with CSHF had significantly higher levels of IFN-? (p=0.002), IL-6 (p=0.001), MMP-2 (p=0.006), ccCK-18 (p<0.001) and ELF biomarkers (p<0.001), compared to those without CSHF. Service uptake was =95%. Direct acting antiviral (DAA) treatment completion was 93% (95% CI 77%-99%), sustained virological response (SVR) being 83% (95% CI 64%-94%). Conclusion There is a significant liver disease burden from HCV and alcohol in PWAH. Non-invasive hepatocyte fibrosis and injury markers can help in identifying such individuals in the community. Despite a challenging cohort, excellent service uptake and high DAA-based SVRs can be achieved.

Funding

Use of non-invasive liver scan to screen for chronic liver disease in vulnerable elderly adults; G1463; DUNHILL MEDICAL TRUST; R369/0714

History

Publication status

  • Published

File Version

  • Accepted version

Journal

Liver International

ISSN

1478-3223

Publisher

Wiley

Issue

3

Volume

42

Page range

628-639

Department affiliated with

  • Clinical and Experimental Medicine Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2021-12-01

First Open Access (FOA) Date

2022-12-01

First Compliant Deposit (FCD) Date

2021-12-01

Usage metrics

    University of Sussex (Publications)

    Categories

    No categories selected

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC