TY - JOUR
T1 - Liver function tests and fibrosis scores in a rural population in Africa
T2 - a cross-sectional study to estimate the burden of disease and associated risk factors
AU - O'Hara, Geraldine
AU - Mokaya, Jolynne
AU - Hau, Jeffrey P
AU - Downs, Louise O
AU - McNaughton, Anna L
AU - Karabarinde, Alex
AU - Asiki, Gershim
AU - Seeley, Janet
AU - Matthews, Philippa C
AU - Newton, Robert
N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
PY - 2020/3/31
Y1 - 2020/3/31
N2 - OBJECTIVES: Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.DESIGN: We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).SETTING: We studied a population cohort in South-Western Uganda.PARTICIPANTS: Data were available for 8099 adults (median age 30 years; 56% female).RESULTS: The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.CONCLUSIONS: Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
AB - OBJECTIVES: Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.DESIGN: We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).SETTING: We studied a population cohort in South-Western Uganda.PARTICIPANTS: Data were available for 8099 adults (median age 30 years; 56% female).RESULTS: The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.CONCLUSIONS: Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
KW - Adolescent
KW - Adult
KW - Cost of Illness
KW - Cross-Sectional Studies
KW - Female
KW - HIV Infections/complications
KW - Humans
KW - Liver/pathology
KW - Liver Cirrhosis/epidemiology
KW - Liver Diseases/complications
KW - Liver Function Tests
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Rural Population
KW - Severity of Illness Index
KW - Uganda/epidemiology
KW - Young Adult
U2 - 10.1136/bmjopen-2019-032890
DO - 10.1136/bmjopen-2019-032890
M3 - Article (Academic Journal)
C2 - 32234740
VL - 10
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
M1 - e032890
ER -