PTU-013 Transient elastography (TE): a screening tool for chronic liver disease in primary care (PC)

Introduction Liver disease is the third leading cause of premature death in England and Wales and is the only major causes of death on the rise. Half of all diagnoses of chronic liver disease are made when patients present to the Emergency Department with decompensated liver disease, and this late presentation incurs a poor prognosis. There has been a push to identify asymptomatic patients with advanced liver fibrosis early to prevent progression to decompensated cirrhosis (NG50 Cirrhosis in over 16s: assessment and management. NICE 2016). TE is increasingly used to screen for advanced fibrosis in patients with risk factors for liver disease for early detection and referral to secondary care (SC)(Harman et al, Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: a cross-sectional diagnostic study utilising transient elastography. BMJ Open 2015). In this study, a hepatology specialist nurse (HSN) provided an outreach service to identify those with advanced fibrosis who would benefit from referral to SC. Methods We carried out a prospective study with high risk patients undergoing TE by a HSN in four general practices in West Berkshire. Risk factors prompting referral for TE include type 2 diabetes mellitus, obesity and excess alcohol use. Referral to SC was advised in those with a TE score >10 kPa. Patients were given lifestyle advice and signposted to appropriate community services (eg drug and alcohol services, eat well services, etc). Data was analysed for rate of detection of significant fibrosis and subsequent diagnosis of advanced liver disease. Results 476 patients, over a 27 month period, with one or more risk factors were identified. 455 underwent TE. 85 (18%) had a TE score >10 kPa, prompting referral to SC. 72 (16%) were seen in a hepatology clinic for further assessment and management. 5 had thrombocytopenia, and 13 had splenomegaly sonographically. 28 (6.2%) underwent a Gastroscopy for variceal surveillance, of which 3 had portal hypertensive gastropathy and 3 had gastro-oesophageal varices. There were 13 (2.9%) newly diagnosed with cirrhosis, 1 with chronic HCV infection, 1 with autoimmune hepatitis, and 1 with a neuroendocrine tumour. Conclusions 3.5% of patients with one or more risk factors for liver disease screened with TE were found to have significant liver disease and 2.9% were cirrhotic on further assessment. This highlights the role for TE in PC to identify high risk patients who would not have otherwise presented to SC until they had progressed to decompensated liver disease. TE is a useful screening test and the majority of patients tested could be managed with advice and lifestyle modification in the community, reserving SC resources for those with higher risk of significant liver disease.