Outreach screening of drug users for cirrhosis with transient elastography

ABSTRACT Aims  Transient elastography (TE) is a non‐invasive sensitive tool for diagnosing cirrhosis in hospital‐based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design  Cross‐sectional study. Setting  All treatment centres in the county of Funen, De...

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Veröffentlicht in:Addiction (Abingdon, England) England), 2011-05, Vol.106 (5), p.970-976
Hauptverfasser: Moessner, Belinda K., Jørgensen, Tina R., Skamling, Merete, Vyberg, Mogens, Junker, Peter, Pedersen, Court, Christensen, Peer B.
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container_end_page 976
container_issue 5
container_start_page 970
container_title Addiction (Abingdon, England)
container_volume 106
creator Moessner, Belinda K.
Jørgensen, Tina R.
Skamling, Merete
Vyberg, Mogens
Junker, Peter
Pedersen, Court
Christensen, Peer B.
description ABSTRACT Aims  Transient elastography (TE) is a non‐invasive sensitive tool for diagnosing cirrhosis in hospital‐based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design  Cross‐sectional study. Setting  All treatment centres in the county of Funen, Denmark. Participants  Drug users attending treatment centres during the presence of the study team. Measurements  Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Findings  Among 175 drug users negative for hepatitis C, 13% had LSM = 8–11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8–11.9 kPa and 21.1% had LSM ≥ 12 kPa (P 
doi_str_mv 10.1111/j.1360-0443.2010.03246.x
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This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design  Cross‐sectional study. Setting  All treatment centres in the county of Funen, Denmark. Participants  Drug users attending treatment centres during the presence of the study team. Measurements  Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Findings  Among 175 drug users negative for hepatitis C, 13% had LSM = 8–11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) &gt; 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8–11.9 kPa and 21.1% had LSM ≥ 12 kPa (P &lt; 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (&lt;12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. Conclusions  Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/j.1360-0443.2010.03246.x</identifier><identifier>PMID: 21182552</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Addictive behaviors ; Adult ; Adult and adolescent clinical studies ; AIDS ; Biological and medical sciences ; Biomarkers - blood ; Biopsy ; Cirrhosis ; Cross-sectional analysis ; Cross-Sectional Studies ; Denmark ; Denmark - epidemiology ; Drug abuse ; Drug addiction ; Drug use ; Drug users ; Elasticity Imaging Techniques ; Evaluation ; Female ; Fibrosis ; Gastroenterology. Liver. Pancreas. Abdomen ; hepatitis C ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - epidemiology ; HIV ; Humans ; hyaluronic acid ; Hyaluronic Acid - blood ; Liver ; Liver - pathology ; Liver cirrhosis ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - epidemiology ; Liver Cirrhosis - pathology ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Mass Screening - methods ; Medical imaging ; Medical sciences ; Medical screening ; Middle Aged ; Other diseases. Semiology ; Patients ; Prevention and actions ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; screening ; Sensitivity and Specificity ; street-based ; Substance Abuse, Intravenous - complications ; Substance Abuse, Intravenous - epidemiology ; transient elastography</subject><ispartof>Addiction (Abingdon, England), 2011-05, Vol.106 (5), p.970-976</ispartof><rights>2010 The Authors, Addiction © 2010 Society for the Study of Addiction</rights><rights>2015 INIST-CNRS</rights><rights>2010 The Authors, Addiction © 2010 Society for the Study of Addiction.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4956-7359ead178d607e335c5b726e64f419f99b03d6c850b49e8011e8cbda8e5520f3</citedby><cites>FETCH-LOGICAL-c4956-7359ead178d607e335c5b726e64f419f99b03d6c850b49e8011e8cbda8e5520f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1360-0443.2010.03246.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1360-0443.2010.03246.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=24073001$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21182552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moessner, Belinda K.</creatorcontrib><creatorcontrib>Jørgensen, Tina R.</creatorcontrib><creatorcontrib>Skamling, Merete</creatorcontrib><creatorcontrib>Vyberg, Mogens</creatorcontrib><creatorcontrib>Junker, Peter</creatorcontrib><creatorcontrib>Pedersen, Court</creatorcontrib><creatorcontrib>Christensen, Peer B.</creatorcontrib><title>Outreach screening of drug users for cirrhosis with transient elastography</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>ABSTRACT Aims  Transient elastography (TE) is a non‐invasive sensitive tool for diagnosing cirrhosis in hospital‐based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design  Cross‐sectional study. Setting  All treatment centres in the county of Funen, Denmark. Participants  Drug users attending treatment centres during the presence of the study team. Measurements  Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Findings  Among 175 drug users negative for hepatitis C, 13% had LSM = 8–11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) &gt; 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8–11.9 kPa and 21.1% had LSM ≥ 12 kPa (P &lt; 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (&lt;12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. Conclusions  Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.</description><subject>Addictive behaviors</subject><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>AIDS</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Biopsy</subject><subject>Cirrhosis</subject><subject>Cross-sectional analysis</subject><subject>Cross-Sectional Studies</subject><subject>Denmark</subject><subject>Denmark - epidemiology</subject><subject>Drug abuse</subject><subject>Drug addiction</subject><subject>Drug use</subject><subject>Drug users</subject><subject>Elasticity Imaging Techniques</subject><subject>Evaluation</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>hepatitis C</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - diagnosis</subject><subject>Hepatitis C, Chronic - epidemiology</subject><subject>HIV</subject><subject>Humans</subject><subject>hyaluronic acid</subject><subject>Hyaluronic Acid - blood</subject><subject>Liver</subject><subject>Liver - pathology</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Patients</subject><subject>Prevention and actions</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>screening</subject><subject>Sensitivity and Specificity</subject><subject>street-based</subject><subject>Substance Abuse, Intravenous - complications</subject><subject>Substance Abuse, Intravenous - epidemiology</subject><subject>transient elastography</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU-P0zAQxS0EYsvCV0AWEuKUMv6b-MBh1WULaJe9gDhajjNpU9Kk2Im2_fY4tBSJC_hia_x7o5n3CKEM5iydt5s5ExoykFLMOaQqCC71fP-IzM4fj8kMjFYZZxIuyLMYNwCQF0Y-JRecsYIrxWfk0_04BHR-TaMPiF3TrWhf0yqMKzpGDJHWfaC-CWHdxybSh2ZY0yG4LjbYDRRbF4d-FdxufXhOntSujfjidF-Srzfvvyw-ZLf3y4-Lq9vMS6N0lgtl0FUsLyoNOQqhvCpzrlHLWjJTG1OCqLQvFJTSYAGMYeHLyhWYJoZaXJI3x7670P8YMQ5220SPbes67MdoDQdQhvP8n2ShmTLMGEjkq7_ITT-GLq2RIDCgpRIJKo6QD32MAWu7C83WhYNlYKdc7MZO9tvJfjvlYn_lYvdJ-vLUfyy3WJ2Fv4NIwOsT4KJ3bZ0c9k38w0nIBQBL3Lsj99C0ePjvAezV9fX0SvrsqG_igPuz3oXvVuciV_bb56VVZnF3o--WloufQxW19A</recordid><startdate>201105</startdate><enddate>201105</enddate><creator>Moessner, Belinda K.</creator><creator>Jørgensen, Tina R.</creator><creator>Skamling, Merete</creator><creator>Vyberg, Mogens</creator><creator>Junker, Peter</creator><creator>Pedersen, Court</creator><creator>Christensen, Peer B.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201105</creationdate><title>Outreach screening of drug users for cirrhosis with transient elastography</title><author>Moessner, Belinda K. ; Jørgensen, Tina R. ; Skamling, Merete ; Vyberg, Mogens ; Junker, Peter ; Pedersen, Court ; Christensen, Peer B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4956-7359ead178d607e335c5b726e64f419f99b03d6c850b49e8011e8cbda8e5520f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Addictive behaviors</topic><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>AIDS</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Biopsy</topic><topic>Cirrhosis</topic><topic>Cross-sectional analysis</topic><topic>Cross-Sectional Studies</topic><topic>Denmark</topic><topic>Denmark - epidemiology</topic><topic>Drug abuse</topic><topic>Drug addiction</topic><topic>Drug use</topic><topic>Drug users</topic><topic>Elasticity Imaging Techniques</topic><topic>Evaluation</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>hepatitis C</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - diagnosis</topic><topic>Hepatitis C, Chronic - epidemiology</topic><topic>HIV</topic><topic>Humans</topic><topic>hyaluronic acid</topic><topic>Hyaluronic Acid - blood</topic><topic>Liver</topic><topic>Liver - pathology</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver Cirrhosis - pathology</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Patients</topic><topic>Prevention and actions</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>screening</topic><topic>Sensitivity and Specificity</topic><topic>street-based</topic><topic>Substance Abuse, Intravenous - complications</topic><topic>Substance Abuse, Intravenous - epidemiology</topic><topic>transient elastography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moessner, Belinda K.</creatorcontrib><creatorcontrib>Jørgensen, Tina R.</creatorcontrib><creatorcontrib>Skamling, Merete</creatorcontrib><creatorcontrib>Vyberg, Mogens</creatorcontrib><creatorcontrib>Junker, Peter</creatorcontrib><creatorcontrib>Pedersen, Court</creatorcontrib><creatorcontrib>Christensen, Peer B.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moessner, Belinda K.</au><au>Jørgensen, Tina R.</au><au>Skamling, Merete</au><au>Vyberg, Mogens</au><au>Junker, Peter</au><au>Pedersen, Court</au><au>Christensen, Peer B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outreach screening of drug users for cirrhosis with transient elastography</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2011-05</date><risdate>2011</risdate><volume>106</volume><issue>5</issue><spage>970</spage><epage>976</epage><pages>970-976</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>ABSTRACT Aims  Transient elastography (TE) is a non‐invasive sensitive tool for diagnosing cirrhosis in hospital‐based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design  Cross‐sectional study. Setting  All treatment centres in the county of Funen, Denmark. Participants  Drug users attending treatment centres during the presence of the study team. Measurements  Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Findings  Among 175 drug users negative for hepatitis C, 13% had LSM = 8–11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) &gt; 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8–11.9 kPa and 21.1% had LSM ≥ 12 kPa (P &lt; 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (&lt;12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. Conclusions  Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21182552</pmid><doi>10.1111/j.1360-0443.2010.03246.x</doi><tpages>7</tpages></addata></record>
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subjects Addictive behaviors
Adult
Adult and adolescent clinical studies
AIDS
Biological and medical sciences
Biomarkers - blood
Biopsy
Cirrhosis
Cross-sectional analysis
Cross-Sectional Studies
Denmark
Denmark - epidemiology
Drug abuse
Drug addiction
Drug use
Drug users
Elasticity Imaging Techniques
Evaluation
Female
Fibrosis
Gastroenterology. Liver. Pancreas. Abdomen
hepatitis C
Hepatitis C, Chronic - complications
Hepatitis C, Chronic - diagnosis
Hepatitis C, Chronic - epidemiology
HIV
Humans
hyaluronic acid
Hyaluronic Acid - blood
Liver
Liver - pathology
Liver cirrhosis
Liver Cirrhosis - diagnosis
Liver Cirrhosis - epidemiology
Liver Cirrhosis - pathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Mass Screening - methods
Medical imaging
Medical sciences
Medical screening
Middle Aged
Other diseases. Semiology
Patients
Prevention and actions
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
screening
Sensitivity and Specificity
street-based
Substance Abuse, Intravenous - complications
Substance Abuse, Intravenous - epidemiology
transient elastography
title Outreach screening of drug users for cirrhosis with transient elastography
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