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Mail-based liver health outreach led to reduced alcohol consumption among at-risk patients

Learning of potential liver risk from heavier alcohol consumption resulted in behavioral changes among responders to a mailed invitation for liver fibrosis screening in a recent community feasibility study.

Researchers in the UK mailed WHO AUDIT questionnaires, assessing alcohol consumption habits, to 9,836 adults, of whom 4,630 responded. Participants considered hazardous or harmful drinkers (AUDIT scores of 8 or greater) were invited to a follow-up visit for liver assessment. The investigators measured liver fibrosis according to the Southampton Traffic Light test (STL), which incorporated hyaluronic acid, collagen P3NP and platelet counts. Patients who were unlikely to have severe liver fibrosis but had the potential for early disease were considered “negative/green,” those with potential fibrosis were classified “positive/amber,” and those with likely fibrosis and potential for severe fibrosis or cirrhosis were defined as “strong positive/red.”

Among patients with AUDIT scores of at least 8, 393 attended follow-up. Three hundred five were considered hazardous drinkers (AUDIT score 8-15) and 88 were harmful/dependent drinkers (score above 15). STL results classified 11% of the cohort in the red category, 40% in amber and 49% in green.

After a median of 370 days, 303 follow-up patients responded to a second AUDIT questionnaire. Overall score decreased by 2.4, with significantly greater reductions among patients classified red or amber. Forty-two percent reduced their AUDIT grade by at least one, while 2.6% had an increased grade from baseline. Patients with an initial red or amber result were more likely to report a reduction of one grade or more (P=.011), with similar results for those with initial scores above 15 (P=.017).

“The study has demonstrated the feasibility of postal screening and liver health check in primary care with promising results on behavior change, and the results should be tested in a randomized controlled trial with economic analysis,” the researchers concluded. “Giving GPs and patients better tools to diagnose early liver disease may eventually help to turn the tide of increasing deaths in the UK.”

Disclosure: The researchers report no relevant financial disclosures.