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

Hashim, Ahmed, Bremner, Stephen, Grove, Jane I, Astbury, Stuart, Mengozzi, Manuela, O'Sullivan, Margaret, Macken, Lucia, Worthley, Tim, Katarey, Dev, Aithal, Guruprasad P and Verma, Sumita (2022) Chronic liver disease in homeless individuals and performance of non-invasive liver fibrosis and injury markers: VALID study. Liver International, 42 (3). pp. 628-639. ISSN 1478-3223

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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.

Item Type: Article
Keywords: homeless people, community health services, fibrosis, hepatitis c, cytokines
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 01 Dec 2021 07:51
Last Modified: 03 Mar 2022 12:45
URI: http://sro.sussex.ac.uk/id/eprint/103176

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Project NameSussex Project NumberFunderFunder Ref
Use of non-invasive liver scan to screen for chronic liver disease in vulnerable elderly adultsG1463DUNHILL MEDICAL TRUSTR369/0714