Advanced liver disease is the second most common cause of lost working years, as it disproportionately affects young patients. A scientific team from MedUni Vienna has been able to determine a threshold value for a simple blood test that can be used to identify people with an increased risk of complications, even without special testing. The research group was also able to demonstrate that non-invasive tests can provide comparable information to minimally invasive tests. The studies have been published in the renowned specialist journals Hepatology and Journal of Hepatology and provide a basis for promoting liver health through early detection.
In Austria, no structured programs are offered for the detection of asymptomatic patients with advanced liver disease, partly because the availability of the special examinations required for this (such as ultrasound-based liver stiffness measurement) is largely limited to specialist hepatology departments.
New laboratory threshold value identifies patients at risk
In the first of the two current studies, the research group at the Department of Medicine III (Clinical Division of Gastroenterology and Hepatology) led by Georg Semmler, Lukas Hartl, Mathias Jachs and Mattias Mandorfer analyzed several thousand patients from Vienna and Salzburg to determine a threshold value for the FIB-4 score (easily calculated in a routine laboratory), which corresponds to a liver stiffness of 10 kPa - i.e. advanced liver disease. The group of people detected by this score have a massively increased risk of liver-related complications (occurrence of abdominal fluid, bleeding from the digestive tract and confusion) and require immediate hepatological evaluation and treatment. "Previous threshold values were either not specific or not sensitive enough, which meant that too many healthy people were incorrectly detected or patients at risk were overlooked," explain the joint first authors Georg Semmler and Lukas Hartl.
Individual risk can be determined gently
In a further study, the research group demonstrated that non-invasive tests (liver stiffness measurement and/or blood tests) can quantify the individual risk of patients just as well as minimally invasive determination of the hepatic vein pressure gradient.
First author Mathias Jachs summarizes: "In high-risk patients, a minimally invasive measurement of the hepatic vein pressure gradient was previously used to determine whether medication should be administered to reduce the likelihood of decompensation. However, this measurement of the hepatic vein pressure gradient represents a burden for patients, albeit a minor one, and above all requires a high level of medical expertise that is not widely available. We have now been able to show that various non-invasive tests can reliably perform this task."
Promoting liver health in Austria
"Despite the great importance of advanced liver disease for the national economy and health and the excellent therapeutic options available with early detection, no appropriate screening has been established in Austria," explains hepatologist Mattias Mandorfer. Known risk factors are obesity, diabetes or alcohol consumption (30g/day for men). "My goal as head of the Hepatology Working Group of the Austrian Society for Gastroenterology and Hepatology (ÖGGH) is to include the FIB-4 threshold value of 1.75 for all patients with risk factors for liver disease in the Austrian health check-up. For the newly detected patients, more sophisticated non-invasive further examinations should be broadly accessible. In addition to liver stiffness measurement and the VITRO score developed in Austria, spleen stiffness measurement will also be of central importance."
Publications:
Hepatology
Simple blood tests to diagnose compensated advanced chronic liver disease and stratify the risk of clinically significant portal hypertension.
Georg Semmler, Lukas Hartl, Yuly Paulin Mendoza, Benedikt Simbrunner, Mathias Jachs, Lorenz Balcar, Michael Schwarz, Benedikt Silvester Hofer, Laurenz Fritz, Anna Schedlbauer, Katharina Stopfer, Daniela Neumayer, Jurij Maurer, Robin Szymanski, Elias Laurin Meyer, Bernhard Scheiner, Peter Quehenberger, Michael Trauner, Elmar Aigner, Annalisa Berzigotti, Thomas Reiberger, Mattias Mandorfer
https://doi.org/10.1097/HEP.0000000000000829
Journal of Hepatology
Prognostic performance of non-invasive tests for portal hypertension is comparable to that of hepatic venous pressure gradient
Mathias Jachs, Lukas Hartl, Benedikt Simbrunner, Georg Semmler, Lorenz Balcar, Benedikt Silvester Hofer, Michael Schwarz, David Bauer, Albert Friedrich Stättermayer, Matthias Pinter, Michael Trauner, Thomas Reiberger, Mattias Mandorfer
https://doi.org/10.1016/j.jhep.2023.12.028
