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. 2018 Jul;16(7):1138-1145.e5.
doi: 10.1016/j.cgh.2017.12.048. Epub 2018 Feb 13.

High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study

Llorenç Caballería  1 , Guillem Pera  1 , Ingrid Arteaga  2 , Lluís Rodríguez  1 , Alba Alumà  3 , Rosa Ma Morillas  4 , Napoleón de la Ossa  5 , Alba Díaz  6 , Carmen Expósito  2 , Dolores Miranda  7 , Carmen Sánchez  8 , Rosa Ma Prats  8 , Marta Urquizu  2 , Angels Salgado  2 , Magda Alemany  2 , Alba Martinez  2 , Irfan Majeed  2 , Núria Fabrellas  9 , Isabel Graupera  10 , Ramón Planas  4 , Isabel Ojanguren  5 , Miquel Serra  11 , Pere Torán  1 , Juan Caballería  10 , Pere Ginès  12
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Free article

High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study

Llorenç Caballería et al. Clin Gastroenterol Hepatol. 2018 Jul.
Free article

Abstract

Background & aims: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease.

Methods: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS.

Results: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed.

Conclusions: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.

Keywords: Cirrhosis; Liver Fibrosis; NAFLD; Transient Elastography.

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