{
  "abstract": "Introduction Mortality from liver disease is rising, largely driven by high levels of alcohol consumption and increasing obesity rates. Liver disease often goes unrecognised in primary care, partly due to lack of standardised pathway to detect liver disease early. There is therefore an urgent need to develop simple tools to detect clinically significant liver disease. The SOLID study aimed to evaluate the performance of liver fibrosis biomarkers to detect advanced chronic liver disease (cACLD) in people with risk factors for liver disease, and to develop novel pathways to detect liver disease in primary care.Methods Patients (18-80 years) with liver disease risk factors (obesity, T2DM or potentially harmful alcohol use) attending a primary care annual health review or NHS Health check who consented had a liver fibrosis assessment, including liver blood tests, FIB-4 and enhanced liver fibrosis test (ELF). Two pathways were evaluated: Pathway 1 - all received blood tests and a fibroscan; Pathway 2 - patients were referred for a fibroscan only if FIB-4 >1.3 and/or ELF >9.8. In both pathways, participants with liver stiffness measurement (LSM) 8kPa were referred for hepatology review. Severity of fibrosis was determined by overall clinical assessment incorporating all investigations, including repeat fibroscan and/or liver biopsy if conducted. ROC analysis was used to determine performance of tests to diagnose cACLD.Results Overall, 2445 participants (mean age 58 ± 11 yrs, 51% male, 27% T2DM, 70% obese and 45% have an AUDIT score >8) had at least one liver fibrosis test. In total, 61 (2.5%) patients were diagnosed with cACLD (44 [1.8%] advanced fibrosis and 17 [0.70%] cirrhosis). 2237 (Pathway 1, n=386; Pathway 2, n=1851) individuals had complete assessments as per protocol and were used to analyse test performance. AUROCs to diagnose cACLD for gamma-glutamyl transferase (GGT), FIB-4 and ELF were 0.83, 0.83 and 0.91, respectively. Figure 1 show diagnostic performance of combinations of GGT, FIB-4 and ELF. Overall, ELF >9.8 alone (figure 1A) had the best performance, detecting 96% of individuals with cACLD. FIB-4 >1.3 followed by ELF >9.8 detected 82% of people with cACLD (figure 1B). A novel pathway, using GGT >40 followed by ELF >9.8 detected 87% of those with cACLD (figure 1C).Conclusions Pathways using ELF had good sensitivity for identifying cACLD among individuals with risk factors for liver disease in primary care. A simple pathway using GGT and ELF may offer a simple, cost efficient and scalable tool to identify people at high risk of cACLD in primary care.Abstract FP26 Figure 1(A) ELF Pathway; (B) FIB-4 AND ELF; (C) GGT AND ELF. Abbreviations: TP: true positive; TN: true negative; FP: false positive; FN: false negative",
  "authors": [
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Liver Unit and NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK",
        "North East and North Cumbria Regional Research Delivery Network, NIHR, UK"
      ],
      "name": "Hannah Starr"
    },
    {
      "affiliations": [
        "North East and North Cumbria Regional Research Delivery Network, NIHR, UK"
      ],
      "name": "Christina Tanney"
    },
    {
      "affiliations": [
        "North West North Tyneside Primary Care Network, UK"
      ],
      "name": "Elizabeth Little"
    },
    {
      "affiliations": [
        "Cruddas Park and Hillview Surgery, Newcastle upon Tyne, UK"
      ],
      "name": "John McGonigle"
    },
    {
      "affiliations": [
        "Alliance Medical Group, Sunderland, UK"
      ],
      "name": "Emily Hadaway"
    },
    {
      "affiliations": [
        "Hadrian Primary Care Alliance, UK"
      ],
      "name": "Rob Forder"
    },
    {
      "affiliations": [
        "North West North Tyneside Primary Care Network, UK"
      ],
      "name": "Eve Wright"
    },
    {
      "affiliations": [
        "Clinical Research Informatics, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Hasena Bell"
    },
    {
      "affiliations": [
        "Clinical Research Informatics, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Trevor Liddle"
    },
    {
      "affiliations": [
        "North East and North Cumbria Regional Research Delivery Network, NIHR, UK"
      ],
      "name": "Jill Deane"
    },
    {
      "affiliations": [
        "North East and North Cumbria Regional Research Delivery Network, NIHR, UK"
      ],
      "name": "Lauren White"
    },
    {
      "affiliations": [
        "North East and North Cumbria Regional Research Delivery Network, NIHR, UK"
      ],
      "name": "Nicola Coverdale"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK",
        "The Bellingham Surgery, UK"
      ],
      "name": "Helen Jarvis"
    },
    {
      "affiliations": [
        "LIVErNORTH Charity, Newcastle upon Tyne, UK"
      ],
      "name": "Joan Bedlington"
    },
    {
      "affiliations": [
        "Department of Blood Sciences, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Ahai Luvai"
    },
    {
      "affiliations": [
        "Department of Clinical Biochemistry, County Durham and Darlington NHS Trust, UK"
      ],
      "name": "Hazel Borthwick"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Gastrointestinal and Liver Services, Gateshead Health NHS Foundation Trust, Gateshead, UK"
      ],
      "name": "Dina Mansour"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Liver Unit and NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Quentin M Anstee"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Liver Unit and NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Stuart McPherson"
    }
  ],
  "title": "FP26 GGT-ELF: a novel risk-stratification pathway to identify advanced liver fibrosis in primary care",
  "uid": "1b8556fd-c02b-541d-b7cd-b8c13862d735"
}