Direct targeting of risk factors significantly increases the detection of XXXX in primary care: a cross-sectional diagnostic study utilising transient elastography.

@entity1 @entity82 @entity6 @entity409 @entity5906 @entity3929 @entity1575 @entity285
OBJECTIVES: To assess the feasibility of a novel diagnostic algorithm targeting @entity1 with risk factors for @entity409 in a community setting. DESIGN: Prospective cross-sectional study. SETTING: Two primary care practices (adult @entity1 population 10   479) in Nottingham, UK. @entity1 : Adult @entity1 (aged 18   years or over) fulfilling one or more selected risk factors for developing @entity409 : (1) hazardous @entity285 use, (2) type 2 @entity6 or (3) persistently elevated @entity3929 aminotransferase (ALT) liver function enzyme with negative serology. INTERVENTIONS: A serial biomarker algorithm, using a simple blood-based marker ( @entity5906 aminotransferase:ALT ratio for hazardous @entity285 users, BARD score for other risk groups) and subsequently liver stiffness measurement using transient elastography (TE). MAIN OUTCOME MEASURES: Diagnosis of clinically significant @entity409 (defined as liver stiffness >= 8   kPa); definitive diagnosis of @entity1575 . RESULTS: We identified 920 @entity1 with the defined risk factors of whom 504 @entity1 agreed to undergo investigation. A normal blood biomarker was found in 62 @entity1 (12.3%) who required no further investigation. Subsequently, 378 @entity1 agreed to undergo TE, of whom 98 (26.8% of valid scans) had elevated liver stiffness. Importantly, 71/98 (72.4%) @entity1 with elevated liver stiffness had normal liver enzymes and would be missed by traditional investigation algorithms. We identified 11 new @entity1 with definite @entity82 , representing a 140% increase in the number of diagnosed cases in this population. CONCLUSIONS: A non-invasive liver investigation algorithm based in a community setting is feasible to implement. Targeting risk factors using a non-invasive biomarker approach identified a substantial number of @entity1 with previously undetected @entity82 . TRIAL REGISTRATION NUMBER: The diagnostic algorithm utilised for this study can be found on clinicaltrials.gov (NCT02037867), and is part of a continuing longitudinal cohort study.
