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

被引:12
作者
Hashim, Ahmed. [1 ,2 ]
Bremner, Stephen [3 ]
Grove, Jane I. [4 ,5 ,6 ]
Astbury, Stuart [4 ,5 ,6 ]
Mengozzi, Manuela [1 ]
O'Sullivan, Margaret [2 ]
Macken, Lucia [1 ,2 ]
Worthley, Tim [7 ]
Katarey, Dev [8 ]
Aithal, Guruprasad P. [4 ,5 ,6 ]
Verma, Sumita [1 ,2 ]
机构
[1] Brighton & Sussex Med Sch, Dept Clin & Expt Med, Brighton, E Sussex, England
[2] Univ Hosp Sussex NHS Fdn Trust, Dept Gastroenterol & Hepatol, Brighton, E Sussex, England
[3] Brighton & Sussex Med Sch, Dept Primary Care & Publ Hlth, Brighton, E Sussex, England
[4] Univ Nottingham, NIHR Nottingham Biomed Res Ctr, Nottingham, England
[5] Nottingham Univ Hosp NHS Trust, Nottingham, England
[6] Univ Nottingham, Sch Med, Nottingham Digest Dis Ctr, Nottingham, England
[7] Arch Hlthcare Brighton, Brighton, E Sussex, England
[8] Royal Free Hosp, Dept Hepatol, London, England
基金
美国国家卫生研究院;
关键词
community health services; cytokines; fibrosis; hepatitis C; homeless people; HEPATITIS-C VIRUS; TRANSIENT ELASTOGRAPHY; HEPCARE EUROPE; PEOPLE; EPIDEMIOLOGY; PREVALENCE; DIAGNOSIS; SEVERITY; SERVICE; CELLS;
D O I
10.1111/liv.15122
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/aims Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remain poorly described. We aimed to determine prevalence/predictors of CLD in PWAH and assess the performance of non-invasive liver 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) >= 8 kPa). 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 = .002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, P = .029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, P < .001) for CSHF as assessed by LSM >= 8 kPa. Those with CSHF had significantly higher levels of IFN-gamma (P = .002), IL-6 (P = .001), MMP-2 (P = .006), ccCK-18 (P < .001) and ELF biomarkers (P < .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 liver 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.
引用
收藏
页码:628 / 639
页数:12
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