Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL.

Autor: Labenz C; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany., Arslanow A; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany., Nguyen-Tat M; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Department of Gastroenterology, Klinikverbund Allgäu, Kempten, Germany., Nagel M; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany., Wörns MA; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany., Reichert MC; Department of Internal Medicine II, University Medical Center Saarland, Homburg, Germany., Heil FJ; Practice Dr. Heil, Andernach, Germany., Mainz D; Practice Dr. Mainz, Saarlouis, Germany., Zimper G; Practice Dr. Zimper, Kirkel, Germany., Römer B; Practice Dr. Römer, Saulheim, Germany., Binder H; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany., Farin-Glattacker E; Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany., Fichtner U; Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany., Graf E; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany., Stelzer D; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany., Van Ewijk R; Statistics and Econometrics, Johannes Gutenberg-University, Mainz, Germany., Ortner J; Department of Law and Economics, Johannes Gutenberg-University, Mainz, Germany., Velthuis L; Department of Law and Economics, Johannes Gutenberg-University, Mainz, Germany., Lammert F; Department of Internal Medicine II, University Medical Center Saarland, Homburg, Germany; Institute for Occupational and Environmental Medicine and Public Health (IAUP), Saarland University, Homburg, Germany; Hannover Health Science Campus, Hannover Medical School (MHH), Hannover, Germany., Galle PR; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. Electronic address: peter.galle@unimedizin-mainz.de.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2022 Sep; Vol. 77 (3), pp. 695-701. Date of Electronic Publication: 2022 Apr 23.
DOI: 10.1016/j.jhep.2022.04.009
Abstrakt: Background & Aims: Detection of patients with early cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. The SEAL program aimed at evaluating the usefulness of a structured screening procedure to detect cirrhosis as early as possible.
Methods: SEAL was a prospective cohort study with a control cohort from routine care data. Individuals participating in the general German health check-up after the age of 35 ("Check-up 35") at their primary care physicians were offered a questionnaire, liver function tests (aspartate and alanine aminotransferase [AST and ALT]), and follow-up. If AST/ALT levels were elevated, the AST-to-platelet ratio index (APRI) score was calculated, and patients with a score >0.5 were referred to a liver expert in secondary and/or tertiary care.
Results: A total of 11,859 participants were enrolled and available for final analysis. The control group comprised 349,570 participants of the regular Check-up 35. SEAL detected 488 individuals with elevated APRI scores (4.12%) and 45 incident cases of advanced fibrosis/cirrhosis. The standardized incidence of advanced fibrosis/cirrhosis in the screening program was slightly higher than in controls (3.83‰ vs. 3.36‰). The comparison of the chance of fibrosis/cirrhosis diagnosis in SEAL vs. in standard care was inconclusive (marginal odds ratio 1.141, one-sided 95% CI 0.801, +Inf). Of note, when patients with decompensated cirrhosis at initial diagnosis were excluded from both cohorts in a post hoc analysis, SEAL was associated with a 59% higher chance of early cirrhosis detection on average than routine care (marginal odds ratio 1.590, one-sided 95% CI 1.080, +Inf; SEAL 3.51‰, controls: 2.21‰).
Conclusions: The implementation of a structured screening program may increase the early detection rate of cirrhosis in the general population. In this context, the SEAL pathway represents a feasible and potentially cost-effective screening program.
Registration: DRKS00013460 LAY SUMMARY: Detection of patients with early liver cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. This study demonstrates that the implementation of a structured screening program using easily obtainable measures of liver function may increase the early detection rate of cirrhosis in the general population. In this context, the 'SEAL' pathway represents a feasible and potentially cost-effective screening program.
Competing Interests: Conflict of interest The authors disclose no potential financial or non-financial conflict of interests regarding this study. Please refer to the accompanying ICMJE disclosure forms for further details.
(Copyright © 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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