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High rates of liver stiffness, fibrosis discovered in general population

Researchers discovered an unexpectedly high prevalence of significant liver fibrosis, mostly related to nonalcoholic fatty liver disease, among a general population cohort of individuals with previously unknown liver disease, according to a recently published study.

“The highest rates were observed among subjects with risk factors for NAFLD and subjects with increased alcohol consumption,” Llorenç Caballería, MD, from the Institut Universitari d’Investigació en Atenció Primària, Barcelona, and colleagues wrote. “Independent predictive factors associated with increased [liver stiffness] were male gender and components of the metabolic syndrome.”

To assess the prevalence of liver fibrosis in the general population, Caballería and colleagues enrolled 3,014 individuals from an urban area of Catalonia, Spain, between Apr. 2012 and Jan. 2016. Participants underwent transient elastography to measure liver stiffness.

The prevalence of increased liver stiffness by cut-off was 9% (95% CI, 8-10.1) for 6.8 kPa or higher, 5.8% (95% CI, 5-6.7) for 8 kPa or higher, and 3.6% (95% CI, 2.9-4.3) for 9 kPa or higher.

Multivariate analysis showed that male sex (OR = 3.01; 95% CI, 2.25-4.05) correlated with increased liver stiffness in the 6.8 kPa or higher cut-off, as did abdominal obesity (OR = 3.84; 95% CI, 2.75-5.34), type 2 diabetes (OR = 2.13; 95% CI, 1.49-3.05), serum glucose of 100 mg/dL or higher (OR = 1.63; 95% CI, 1.18-2.24), low HDL (OR = 1.51; 95% CI, 1.1-2.07), triglyceride levels of 150 mg/dL or higher (OR = 1.63; 95% CI, 1.21-2.19), and increased alanine aminotransferase or aspartate aminotransferase levels (OR = 2.15; 95% CI, 1.48-3.12). The odds ratios remained nearly identical in the 8 kPa or higher and 9 kPa or higher cut-offs.

Of the 179 participants with liver stiffness of 6.8 kPa or higher or increased ALT who accepted hepatology consultation, 92 consented to a liver biopsy. After liver biopsy, the researchers found 81 participants had NAFLD and seven had alcoholic liver disease.

Among the participants with biopsy-proven liver disease, the researchers observed significant fibrosis in 32% of those in the 6.8 kPA or higher cut-off, 45% of those in the 8 kPa or higher cut-off, and 65% of those in the 9 kPa or higher cut-off.

Final analysis showed that a cut-off of 9.2 kPa best predicted the presence of significant liver fibrosis with a sensitivity of 93%, specificity of 78% and predictive accuracy of 83%.

The researchers suggest a 3-step algorithm for fibrosis screening in primary care: assess risk factors for liver fibrosis, including metabolic syndrome and alcohol risk consumption; exclude patients with a fibrosis liver index less than 60; and perform transient elastography in patients with risk factors and fibrosis liver index of 60 or higher.

“These data highlight the relevance of NAFLD as a major health issue and suggests that effective screening, preventive and therapeutic measures should be taken to reduce the present and future impact of this disease in the population,” Caballería and colleagues concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.