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
JANE GROVE firstname.lastname@example.org
STUART ASTBURY STUART.ASTBURY@NOTTINGHAM.AC.UK
GURUPRASAD AITHAL Guru.Aithal@nottingham.ac.uk
Professor of Hepatology
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.
Hashim, A., Bremner, S., Grove, J., Astbury, S., Mengozzi, M., O’Sullivan, M., …Verma, S. (2021). Chronic Liver Disease in Homeless Individuals and Performance of Non-Invasive Liver Fibrosis and Injury Markers: VALID Study. Liver International, https://doi.org/10.1111/liv.15122
|Journal Article Type||Article|
|Acceptance Date||Nov 25, 2021|
|Online Publication Date||Nov 30, 2021|
|Publication Date||Nov 30, 2021|
|Deposit Date||Nov 26, 2021|
|Publicly Available Date||Dec 1, 2022|
|Peer Reviewed||Peer Reviewed|
|Keywords||homeless people, community health services, fibrosis, hepatitis C, cytokines|
This file is under embargo until Dec 1, 2022 due to copyright restrictions.
You might also like
MR Measures of Small Bowel Wall T2 Are Associated With Increased Permeability