title: Outreach screening of drug users for cirrhosis with transient elastography.
abstract: OBJECTIVE
  Transient elastography (TE) is a non-invasive sensitive tool for diagnosing cirrhosis in hospital-based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All treatment centres in the county of Funen, Denmark.
  
  
  METHODS
  Drug users attending treatment centres during the presence of the study team.
  
  
  METHODS
  Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy.
  
  
  RESULTS
  Among 175 drug users negative for hepatitis C, 13% had LSM = 8-11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8-11.9 kPa and 21.1% had LSM ≥ 12 kPa (P < 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (<12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity.
  
  
  CONCLUSIONS
  Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. belinda.klemmensen@gmail.com
authors.forename: Belinda K
authors.initials: BK
authors.lastname: Moessner
authors.forename: Tina R
authors.initials: TR
authors.lastname: Jørgensen
authors.forename: Merete
authors.initials: M
authors.lastname: Skamling
authors.forename: Mogens
authors.initials: M
authors.lastname: Vyberg
authors.forename: Peter
authors.initials: P
authors.lastname: Junker
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Peer B
authors.initials: PB
authors.lastname: Christensen
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D054459:Elasticity Imaging Techniques; D005260:Female; D005355:Fibrosis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid