Proactive case finding of alcohol-related liver disease in high-risk populations: A systematic review

Ann J Archer*, Jennifer Phillips, Mohsan Subhani, Zoe Ward, Fiona H Gordon, Matthew Hickman, Ashwin D Dhanda, Kushala W M Abeysekera

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

Abstract

Background:
Alcohol-related liver disease (ARLD) is often diagnosed at a late stage when mortality is unacceptably high. Earlier identification of ARLD may lead to reduced alcohol intake, participation in hepatocellular carcinoma surveillance and reduction in liver-related morbidity and mortality. People with alcohol use disorder (AUD) are at highest risk of ARLD. The aim of this systematic review was to understand the yield of proactive screening for ARLD amongst high-risk groups.

Methods:
Embase, Medline, Scopus and grey literature were searched for studies describing proactive assessment for alcohol-related liver disease in people with a history of alcohol excess or diagnosed AUD. Outcomes of interest were fibrosis and cirrhosis detection rates, clinical outcomes, portal hypertension evaluation, attendance at follow-up and cost-effectiveness.

Results:
Fifteen studies were identified for inclusion from 1115 returned by the search. Four key settings for patient engagement were identified as inpatient addiction services, outpatient addiction services, general acute hospital admissions and community outreach. Of these, acute hospital admissions were the highest yield for cirrhosis at 10.8%–29.6% and community outreach the lowest was 1.2%–2.3%.

Conclusions:
Targeted fibrosis assessment of high-risk populations for ARLD is feasible to conduct and identifies a proportion of patients at risk of advanced liver disease. The highest yield is amongst inpatients admitted with AUD. Prospective work is needed to establish which are the most effective and acceptable screening methods and the impact on long-term outcomes.

Original languageEnglish
Pages (from-to)1298-1308
Number of pages11
JournalLiver International
Volume44
Issue number6
Early online date8 Mar 2024
DOIs
Publication statusE-pub ahead of print - 8 Mar 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Liver International published by John Wiley & Sons Ltd.

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