Acceptability of non-invasive liver fibrosis screening in psychiatric settings

Abstract

Objectives: Psychiatric patients are frequently exposed to factors that increase their risk of developing chronic liver diseases. These factors include the presence of metabolic syndrome, high rates of current or past alcohol and illicit substance use, and the direct liver toxicity of certain psychiatric medications. Despite this, systematic screening for chronic liver diseases in this population is not routine. Transient elastography (FibroScan®), a non-invasive method to assess liver stiffness, could facilitate early detection of advanced hepatic fibrosis. This study aimed to assess the acceptability of non-invasive liver fibrosis evaluation using FibroScan® among psychiatric inpatients and to evaluate the prevalence of alcohol and illicit drug use, viral hepatitis, significant liver fibrosis, and linkage to somatic care.

Methods: This prospective, interventional cohort study was conducted in a tertiary psychiatric hospital from March 2023 to January 2024. Liver stiffness measurement (LSM) by transient elastography (FibroScan®) screening for the detection of significant liver fibrosis was proposed to all hospitalized patients after providing informed consent. Patients responded to a structured interview that included the AUDIT-C questionnaire to assess alcohol use disorders, along with items on illicit drug use and other liver disease risk factors like metabolic syndrome or viral hepatitis. Significant fibrosis was defined as liver stiffness measurement (LSM) ≥10kPa. Demographic, clinical, biological and virological data was collected from patients' medical files.

Results: A total of 180 patients were included in the study, with 122 (67.8%) consenting to FibroScan® screening. The cohort's mean age was 44.4±15.5 years, with 61% male. The seroprevalence of HCV antibodies was 2.5%, with a higher prevalence among men (6.5%). Chronic HBV infection prevalence was 0.81%. Metabolic syndrome was present in 28.7% of patients. Alcohol use disorders were identified in 45.9% of patients, with men showing higher AUDIT-C scores than women (P=0.04). Drug use was reported by 37.7% of patients, with recent use in 20%. Significant fibrosis was detected in 0.8% of patients and linkage to care was provided in this case.

Conclusions: Transient elastography is an acceptable method for screening hepatic fibrosis in psychiatric settings. It represents an excellent option to assess other associated comorbidities in this underserved population and improve linkage to somatic care.

Keywords: Dépistage non invasif de la fibrose hépatique; FibroScan; Liver fibrosis; Maladies chroniques du foie; Noninvasive screening; Psychiatric patients; Psychiatrie; Viral hepatitis.