Liver fibrosis screening increases alcohol abstinence

Abstract

Background & aims: Individuals with alcohol use disorder (AUD) are at risk of liver disease. There is scarce information on the effectiveness of screening for liver fibrosis on alcohol consumption. Thus, we evaluated the efficacy of a screening program for liver fibrosis on alcohol consumption in individuals with AUD.

Methods: We performed a prospective interventional study in the Hospital Clinic of Barcelona. The screening cohort included individuals with AUD from the addiction unit who underwent screening for liver fibrosis with transient elastography and counselling on lifestyle habits in the liver unit. The control cohort included individuals with similar characteristics who attended the same unit in a previous period but did not undergo screening. Effects on alcohol consumption were evaluated at 6 months, after clinical follow-up, with clinical assessment by addiction specialists and urine ethyl glucuronide monitoring.

Results: In the screening cohort, 149/334 (45%) individuals were abstinent at 6 months (68% confirmed with urine ethyl glucuronide). Alcohol abstinence was higher in the screening cohort than in the control cohort (40/137 [29%], p = 0.002). Factors associated with alcohol abstinence in the multivariate analysis of the two combined cohorts (n = 471) were: receiving AUD medications (odds ratio [OR] 1.72, 95% CI 1.11-2.67), absence of illicit drug use (OR 0.50, 95% CI 0.31-0.80) and participating in the screening program (OR 1.77, 95% CI 1.14-2.74). In the screening cohort, 40 (12%) individuals had increased liver stiffness (≥8 kPa), which was associated with obesity (p = 0.03), arterial hypertension (p = 0.03), gamma-glutamyltransferase (p <0.001) and platelet levels (p = 0.001).

Conclusions: This study shows that an integrated screening program for liver fibrosis associated with counselling on alcohol consumption in individuals with AUD allows for early diagnosis of alcohol-associated liver disease and is associated with alcohol abstinence.

Impact and implications: Individuals with high alcohol consumption are at higher risk of liver disease compared to the general population. The potential beneficial effects of screening for liver disease in this population have scarcely been studied. We show that a screening program for liver fibrosis together with a lifestyle counselling intervention favoured alcohol abstinence among individuals with alcohol use disorder attending an addiction unit at 6 months, compared to a matched cohort who did not undergo screening. These findings suggest that screening programs for liver fibrosis have a therapeutic role in individuals with alcohol use disorder, supporting the implementation of these programs in addiction units.

Keywords: Addiction; Alcohol-related Liver Disease; Biomarker; Elastography; Stiffness.

Graphical abstract

Fig. 1

Study design and flowchart of the individuals included in the study. V0 = first visit in the addiction unit; V1 = first visit in the liver unit; V2 = second visit in the liver unit; V6 = 6-month follow-up visit. ^aThreshold of high-risk: weekly intake of at least 21/14 SD (1 SD = 10 g of alcohol) for men/women for at least 1 year and/or persistent binge drinking (>6 months). AUD, alcohol use disorder; LSM, liver stiffness measurement; LTs, liver tests; SD, standard drink of alcohol.

Fig. 2

Alcohol consumption at baseline and at 6 months’ follow-up in the screening and control cohorts.

Fig. 3

Grade of liver fibrosis using the Metavir scale for patients with liver stiffness <8 kPa, 8-15 kPa and >15 kPa. LSM, liver stiffness measurement.