{ "abstract": "Introduction Steatotic liver disease is prevalent in primary care due to high rates of obesity and harmful alcohol consumption and frequently goes unrecognised, leading to late presentation with cirrhosis. There is therefore a need to develop more effective ways of identifying clinically significant liver disease to enable treatment to prevent progression to cirrhosis. The SOLID study aimed to evaluate the performance of liver fibrosis biomarkers to identify advanced chronic liver disease (cACLD) in primary care. Our aim was to assess the diagnostic performance of available blood tests to diagnose people with cACLD.Methods Patients with risk factors for liver disease (obesity, T2DM or potentially harmful alcohol use) attending a primary care annual health review or NHS Health check were invited to participate and those 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 patients received blood tests and a fibroscan; Pathway 2 - patients had a fibroscan if FIB-4 >1.3 and/or ELF >9.8. Participants with liver stiffness measurement (LSM) 8kPa were referred for hepatology review. The reference standard was the presence of cACLD as determined by overall clinical assessment by an expert hepatologist incorporating all tests, including repeat fibroscan and liver biopsy, where indicated. ROC analysis was used to determine performance of tests to diagnose cACLD.Results Overall, 2237 (Pathway 1, n=386; Pathway 2, n=1851) participants had all fibrosis tests as per protocol and were used to analyse test performance (mean age 58 ± 11 years, 51% male, 26% T2DM, 69% obese and 46% AUDIT score >8). In total, 46 had cACLD (2.1%; 33 [1.5%] advanced fibrosis and 13 [0.6%] cirrhosis). The performance of liver blood tests (ALT, AST and GGT), FIB-4 and ELF to diagnose cACLD is shown in table 1. The overall performance of ELF was excellent with high sensitivity (96%) and acceptable specificity (75%) for cACLD at 9.8. GGT also performed well with a high sensitivity (89%) and acceptable specificity (66%) at a cut-off of 40 U/L, which was comparable to FIB-4 (sensitivity 83%, specificity 65% at 1.3). Of note, ALT, which is most frequent liver blood test performed in primary care, had the worst performance.Conclusions Overall, ELF had excellent performance to identify people with cACLD in a primary care cohort with risk factors for liver disease. GGT had similar performance to FIB-4 so may offer a simpler alternative to FIB-4 as a tool to identify patients at high risk of cACLD.Abstract O50 Table 1TestAUROC95% CICut-offSensitivitySpecificityALT0.740.67-0.804146%86%ALT (F)0.720.59-0.851983%45%ALT (M)0.710.62-0.803071%59%AST0.830.76-0.893165%80%ELF0.910.88-0.949.896%75%ELF0.910.88-0.9410.5152%94%FIB-40.830.77-0.901.383%65%GGT0.830.76-0.904089%66%HbA1c0.740.66,0.824273%64%", "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 upon Tyne, UK", "The Bellingham Surgery, Northumberland, 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": "O50 How well do liver fibrosis biomarkers perform to identify advanced chronic liver disease in primary care?", "uid": "d38da809-6bbf-5fbd-ae5e-e5ac9409e91e" }