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

Hashim, A; Bremner, S; Grove, JI; Astbury, S; Mengozzi, M; O’Sullivan, M; Macken, L; Worthley, T; Katarey, D; Aithal, GP; Verma, S

Abstract

Background/aims: Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remains poorly described. We aimed to determine prevalence/predictors of chronic liver disease (CLD) in PWAH and assess performance of non-invasive hepatocyte 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) > 8kPa).
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=0.002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, p=0.029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, p<0.001) for CSHF as assessed by LSM >8kPa. Those with CSHF had significantly higher levels of IFN-γ (p=0.002), IL-6 (p=0.001), MMP-2 (p=0.006), ccCK-18 (p<0.001) and ELF biomarkers (p<0.001), 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 hepatocyte 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.

Citation

Hashim, A., Bremner, S., Grove, J., Astbury, S., Mengozzi, M., O’Sullivan, M., …Verma, S. (2022). Chronic liver disease in homeless individuals and performance of non‐invasive liver fibrosis and injury markers: VALID study. Liver International, 42(3), 628-639. https://doi.org/10.1111/liv.15122

• Journal Article Type: Article
• Acceptance Date: Nov 25, 2021
• Online Publication Date: Dec 10, 2021
• Publication Date: 2022-03
• Deposit Date: Nov 26, 2021
• Publicly Available Date: Dec 11, 2022
• Journal: Liver International
• Print ISSN: 1478-3223
• Electronic ISSN: 1478-3231
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 3
• Pages: 628-639
• DOI: https://doi.org/10.1111/liv.15122
• Keywords: homeless people, community health services, fibrosis, hepatitis C, cytokines
• Public URL: https://nottingham-repository.worktribe.com/output/6789593
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/liv.15122
• Additional Information: This is the peer reviewed version of the following article: Hashim, A, Bremner, S, Grove, JI, et al. Chronic liver disease in homeless individuals and performance of non-invasive liver fibrosis and injury markers: VALID study. Liver Int. 2022; 42: 628– 639., which has been published in final form at doi:10.1111/liv.15122. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.