The role of elastography for liver fibrosis screening in alcoholic liver disease

Non-invasive tests have been developed to determine the severity of liver disease in patients with alcohol use disorder (AUD). We aimed to assess the severity of liver steatosis and liver fibrosis (LF) in a cohort of patients with AUD using liver elastography and biological scores. Materials and methods: A prospective study was performed on 172 subjects, without previously known liver disease, with a positive AUDIT-C score, serum markers, and vibration-controlled transient elastography (VCTE) with Controlled Attenuation Parameter (CAP). Results: From 172 subjects with positive AUDIT-C test, VCTE diagnosed advanced fibrosis (F3) in 13.9% (24/172) of the subjects and liver cirrhosis (F4) in 17.5% (30/172). Moderate and severe steatosis was found in 18.6% (32/172), respectively 52.3% (90/172). Significant correlations were found between liver stiffness and APRI (r=0.33, p=0.001), FIB-4(r=0.31, p=0.0012) and the age-platelet index (r=0.25, p=0.008). FIB-4 (p=0.01) and age-platelet index (p=0.03) were independently associated with the presence of advanced fibrosis. Age-platelet index (AUC- 0.82) performed significantly better than AST/ALT (AUC- 0.55) and APRI (AUC- 0.58) (p= 0.0001 and p= 0.0014, respectively), but no differences were found when compared to FIB-4 (AUC- 0.77) (p=0.35) for predicting advanced fibrosis. Conclusion: In conclusion, in a cohort of patients with AUD, 70.9% presented moderate and severe liver steatosis and 17.5% were newly diagnosed with liver cirrhosis.