Making the case for the routine screening of liver fibrosis
Liver cirrhosis is a life-threatening condition that effects an estimated 10 million Europeans. While liver cirrhosis is generally untreatable, liver fibrosis – the accumulation of scar tissue in the liver that leads to cirrhosis – is reversible. In other words, by treating liver fibrosis, one can prevent liver cirrhosis. But that’s easier said than done. “Liver fibrosis is often difficult to diagnose in early stages because it does not cause symptoms until advanced scarring occurs, at which point it’s often too late to treat and patients could die or require a liver transplant,” says Pere Ginès, a professor of medicine at the University of Barcelona(opens in new window). With the support of the EU-funded LiverScreen project(opens in new window), Ginès is leading an effort to develop a process for diagnosing chronic liver disease early enough that it can still be treated. “We want to be able to screen the general population for liver fibrosis in a manner similar to how we currently screen for colorectal, breast, and prostate cancers,” adds Ginès. The project also aimed to identify the key risk factors for chronic liver diseases.
Many adults have undiagnosed liver fibrosis
With a team of researchers coming from nine EU countries, the project recruited over 30 000 individuals without known liver disease. “This is by far the largest population-based cohort in the world with liver phenotype – a database that we will make available to others studying liver disease,” explains Ginès. Based on this cohort, researchers found that approximately 2 % of the European adult population has undiagnosed advanced-stage liver fibrosis. The project also identified a large proportion of people at risk of developing chronic liver disease. “These numbers show that a significant amount of people stand to benefit from preventive and therapeutic measures that could, at the very least, prevent the disease from progressing if not cure it,” notes Ginès.
A new way to screen for liver fibrosis
Another key outcome of the project is a new concept to screen for liver fibrosis. Called LiverRisk(opens in new window), the concept uses an algorithm to detect the presence of liver fibrosis in adults without known liver disease. It also provides a prediction on the long-term risk of dying from liver disease. “This is a simple tool, available as an app or from a website, that clinicians can download and use to quickly calculate a patient’s liver risk score,” remarks Ginès. To calculate the score, all one needs to enter is the patient’s age, sex and six laboratory variables: glucose, cholesterol, AST, ALT, GGT, and platelet count. The free app can be downloaded here(opens in new window).
A new tool in the fight against chronic non-communicable diseases
Laying the foundation for the routine screening of liver fibrosis, the LiverScreen project helps advance Europe’s fight against chronic non-communicable diseases – which are the most common cause of death in the world. “Since chronic liver diseases are the origin of liver cancer, screening for liver diseases – followed by appropriate treatment – can help reduce the burden of liver cancer,” concludes Ginès. Researchers are now preparing a randomised controlled trial to demonstrate how liver fibrosis screening reduces long-term mortality due to chronic liver diseases.
