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Universal alcohol screening may help reduce severe liver damage

BARCELONA — New research presented at the International Liver Congress showed universal screening for alcohol in hospital settings may be able to identify individuals at greatest risk for alcohol-related harm, and, in turn, reduce the risk for more severe liver damage in the future.

“Many who die from cirrhosis due to alcohol-related harm have a history of recurrent hospital admissions, meaning we are missing chances to offer treatment,” Richard Aspinall, MD, consultant hepatologist, Portsmouth Hospitals NHS Trust, UK, said in a press release. “This study shows that universal screening for alcohol misuse among patients admitted to acute medical units is both achievable and can help inform targeted interventions.”

Aspinall and colleagues systematically screened 53,165 individuals admitted to the acute medical unit of a major acute hospital between July 2011 and March 2014. Individuals found at increasing risk for alcohol harm were referred for brief intervention or assessment by an alcohol specialist nurse service. A total of 48,211 patients completed the screening and of these, 2.3% were considered to be at increasing risk for alcohol harm (n = 1,122) and 4% were at high risk for alcohol harm (n = 1,921).

Results of the screening showed that high risk patients had more hospital admissions in the past 3 years (4.74%) compared with the low risk (3%) and increasing risk (2.92%) for alcohol harm groups (P < .001). The high risk patients also had more visits to the ED (7.68%) compared with the lower risk (2.65%) and increasing risk groups (3.81%; P < .001 for both).

A total of 72.6% of high risk individuals were seen by the alcohol specialist nurse service (n = 1,396) and 81.2% of these had an AUDIT score over 20 (n = 1,135). Nearly 38% of these had a maximum AUDIT value of 40.

Aspinall and colleagues concluded: “Universal screening of admissions for alcohol misuse is achievable and identifies a cohort with frequent ED attendances, recurrent admissions and an elevated risk of [alcohol-related liver disease]. An additional group of patients at increasing risk of alcohol harm can be identified in a range of general medical presentations.”

“This study places a spotlight on the significant burden alcohol misuse poses to health services, and the potential benefit of screening in reducing this burden. Providing interventions for those at high risk of alcohol harm is vital. Creating a culture supportive of healthy behavioral change to help reduce alcohol consumption in Europe is however equally as important if we are to address the root cause of this problem,” Laurent Castera, MD, PhD, EASL secretary general said in a press release. – by Melinda Stevens

Reference:

Aspinall R, et al. Abstract THU-312. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.

Disclosure: Aspinall reports no relevant financial disclosures. Please see the abstract for a list of all other researchers’ relevant financial disclosures.