Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL

Publikationstyp:
Zeitschriftenaufsatz
Metadaten:
Autoren
  • Christian Labenz
  • Anita Arslanow
  • Marc Nguyen-Tat
  • Michael Nagel
  • Marcus-Alexander Woerns
  • Matthias Christian Reichert
  • Franz Josef Heil
  • Dagmar Mainz
  • Gundula Zimper
  • Barbara Roemer
  • Harald Binder
  • Erik Farin-Glattacker
  • Urs Fichtner
  • Erika Graf
  • Dominikus Stelzer
  • Reyn Van Ewijk
  • Julia Ortner
  • Louis Velthuis
  • Frank Lammert
  • Peter R Galle
Autoren-URL
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=fis-test-1&SrcAuth=WosAPI&KeyUT=WOS:000885326300014&DestLinkType=FullRecord&DestApp=WOS_CPL
DOI
10.1016/j.jhep.2022.04.009
eISSN
1600-0641
Externe Identifier
  • Clarivate Analytics Document Solution ID: 6H3EA
  • PubMed Identifier: 35472313
ISSN
0168-8278
Ausgabe der Veröffentlichung
3
Zeitschrift
JOURNAL OF HEPATOLOGY
Schlüsselwörter
  • cirrhosis
  • liver fibrosis
  • non-invasive test
  • screening
Paginierung
695 - 701
Datum der Veröffentlichung
2022
Status
Published
Titel
Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL
Sub types
  • Article
Ausgabe der Zeitschrift
77

Datenquelle: Web of Science (Lite)

Andere Metadatenquellen:
Autoren
  • Christian Labenz
  • Anita Arslanow
  • Marc Nguyen-Tat
  • Michael Nagel
  • Marcus-Alexander Wörns
  • Matthias Christian Reichert
  • Franz Josef Heil
  • Dagmar Mainz
  • Gundula Zimper
  • Barbara Römer
  • Harald Binder
  • Erik Farin-Glattacker
  • Urs Fichtner
  • Erika Graf
  • Dominikus Stelzer
  • Reyn Van Ewijk
  • Julia Ortner
  • Louis Velthuis
  • Frank Lammert
  • Peter R Galle
DOI
10.1016/j.jhep.2022.04.009
ISSN
0168-8278
Ausgabe der Veröffentlichung
3
Zeitschrift
Journal of Hepatology
Sprache
en
Paginierung
695 - 701
Datum der Veröffentlichung
2022
Status
Published
Herausgeber
Elsevier BV
Herausgeber URL
http://dx.doi.org/10.1016/j.jhep.2022.04.009
Datum der Datenerfassung
2023
Titel
Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL
Ausgabe der Zeitschrift
77

Datenquelle: Crossref

Abstract
<h4>Background & aims</h4>Detection of patients with early cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. The SEAL program aimed at evaluating the usefulness of a structured screening procedure to detect cirrhosis as early as possible.<h4>Methods</h4>SEAL was a prospective cohort study with a control cohort from routine care data. Individuals participating in the general German health check-up after the age of 35 ("Check-up 35") at their primary care physicians were offered a questionnaire, liver function tests (aspartate and alanine aminotransferase [AST and ALT]), and follow-up. If AST/ALT levels were elevated, the AST-to-platelet ratio index (APRI) score was calculated, and patients with a score >0.5 were referred to a liver expert in secondary and/or tertiary care.<h4>Results</h4>A total of 11,859 participants were enrolled and available for final analysis. The control group comprised 349,570 participants of the regular Check-up 35. SEAL detected 488 individuals with elevated APRI scores (4.12%) and 45 incident cases of advanced fibrosis/cirrhosis. The standardized incidence of advanced fibrosis/cirrhosis in the screening program was slightly higher than in controls (3.83‰ vs. 3.36‰). The comparison of the chance of fibrosis/cirrhosis diagnosis in SEAL vs. in standard care was inconclusive (marginal odds ratio 1.141, one-sided 95% CI 0.801, +Inf). Of note, when patients with decompensated cirrhosis at initial diagnosis were excluded from both cohorts in a post hoc analysis, SEAL was associated with a 59% higher chance of early cirrhosis detection on average than routine care (marginal odds ratio 1.590, one-sided 95% CI 1.080, +Inf; SEAL 3.51‰, controls: 2.21‰).<h4>Conclusions</h4>The implementation of a structured screening program may increase the early detection rate of cirrhosis in the general population. In this context, the SEAL pathway represents a feasible and potentially cost-effective screening program.<h4>Registration</h4>DRKS00013460 LAY SUMMARY: Detection of patients with early liver cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. This study demonstrates that the implementation of a structured screening program using easily obtainable measures of liver function may increase the early detection rate of cirrhosis in the general population. In this context, the 'SEAL' pathway represents a feasible and potentially cost-effective screening program.
Addresses
  • Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Autoren
  • Christian Labenz
  • Anita Arslanow
  • Marc Nguyen-Tat
  • Michael Nagel
  • Marcus-Alexander Wörns
  • Matthias Christian Reichert
  • Franz Josef Heil
  • Dagmar Mainz
  • Gundula Zimper
  • Barbara Römer
  • Harald Binder
  • Erik Farin-Glattacker
  • Urs Fichtner
  • Erika Graf
  • Dominikus Stelzer
  • Reyn Van Ewijk
  • Julia Ortner
  • Louis Velthuis
  • Frank Lammert
  • Peter R Galle
DOI
10.1016/j.jhep.2022.04.009
eISSN
1600-0641
Externe Identifier
  • PubMed Identifier: 35472313
Open access
false
ISSN
0168-8278
Ausgabe der Veröffentlichung
3
Zeitschrift
Journal of hepatology
Schlüsselwörter
  • Humans
  • Liver Cirrhosis
  • Fibrosis
  • Alanine Transaminase
  • Aspartate Aminotransferases
  • Platelet Count
  • Prospective Studies
  • Biomarkers
Sprache
eng
Medium
Print-Electronic
Online publication date
2022
Paginierung
695 - 701
Datum der Veröffentlichung
2022
Status
Published
Datum der Datenerfassung
2022
Titel
Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL.
Sub types
  • Research Support, Non-U.S. Gov't
  • Journal Article
Ausgabe der Zeitschrift
77

Datenquelle: Europe PubMed Central

Abstract
BACKGROUND & AIMS: Detection of patients with early cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. The SEAL program aimed at evaluating the usefulness of a structured screening procedure to detect cirrhosis as early as possible. METHODS: SEAL was a prospective cohort study with a control cohort from routine care data. Individuals participating in the general German health check-up after the age of 35 ("Check-up 35") at their primary care physicians were offered a questionnaire, liver function tests (aspartate and alanine aminotransferase [AST and ALT]), and follow-up. If AST/ALT levels were elevated, the AST-to-platelet ratio index (APRI) score was calculated, and patients with a score >0.5 were referred to a liver expert in secondary and/or tertiary care. RESULTS: A total of 11,859 participants were enrolled and available for final analysis. The control group comprised 349,570 participants of the regular Check-up 35. SEAL detected 488 individuals with elevated APRI scores (4.12%) and 45 incident cases of advanced fibrosis/cirrhosis. The standardized incidence of advanced fibrosis/cirrhosis in the screening program was slightly higher than in controls (3.83‰ vs. 3.36‰). The comparison of the chance of fibrosis/cirrhosis diagnosis in SEAL vs. in standard care was inconclusive (marginal odds ratio 1.141, one-sided 95% CI 0.801, +Inf). Of note, when patients with decompensated cirrhosis at initial diagnosis were excluded from both cohorts in a post hoc analysis, SEAL was associated with a 59% higher chance of early cirrhosis detection on average than routine care (marginal odds ratio 1.590, one-sided 95% CI 1.080, +Inf; SEAL 3.51‰, controls: 2.21‰). CONCLUSIONS: The implementation of a structured screening program may increase the early detection rate of cirrhosis in the general population. In this context, the SEAL pathway represents a feasible and potentially cost-effective screening program. REGISTRATION: DRKS00013460 LAY SUMMARY: Detection of patients with early liver cirrhosis is of importance to prevent the occurrence of complications and improve prognosis. This study demonstrates that the implementation of a structured screening program using easily obtainable measures of liver function may increase the early detection rate of cirrhosis in the general population. In this context, the 'SEAL' pathway represents a feasible and potentially cost-effective screening program.
Date of acceptance
2022
Autoren
  • Christian Labenz
  • Anita Arslanow
  • Marc Nguyen-Tat
  • Michael Nagel
  • Marcus-Alexander Wörns
  • Matthias Christian Reichert
  • Franz Josef Heil
  • Dagmar Mainz
  • Gundula Zimper
  • Barbara Römer
  • Harald Binder
  • Erik Farin-Glattacker
  • Urs Fichtner
  • Erika Graf
  • Dominikus Stelzer
  • Reyn Van Ewijk
  • Julia Ortner
  • Louis Velthuis
  • Frank Lammert
  • Peter R Galle
Autoren-URL
https://www.ncbi.nlm.nih.gov/pubmed/35472313
DOI
10.1016/j.jhep.2022.04.009
eISSN
1600-0641
Ausgabe der Veröffentlichung
3
Zeitschrift
J Hepatol
Schlüsselwörter
  • cirrhosis
  • liver fibrosis
  • non-invasive test
  • screening
  • Alanine Transaminase
  • Aspartate Aminotransferases
  • Biomarkers
  • Fibrosis
  • Humans
  • Liver Cirrhosis
  • Platelet Count
  • Prospective Studies
Sprache
eng
Country
Netherlands
Paginierung
695 - 701
PII
S0168-8278(22)00244-6
Datum der Veröffentlichung
2022
Status
Published
Datum, an dem der Datensatz öffentlich gemacht wurde
2022
Titel
Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL.
Sub types
  • Journal Article
  • Research Support, Non-U.S. Gov't
Ausgabe der Zeitschrift
77

Datenquelle: PubMed

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