ArticleBMJ open2015
Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: a cross-sectional diagnostic study utilising transient elastography.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02037867 (The Stratification of Liver Disease in the Community Using Fibrosis Biomarkers), which is not on this map. Cited by 47 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Stratification of Liver Disease in the Community Using Fibrosis Biomarkers
Who cites it
47 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Detection of undiagnosed liver cirrhosis via AI-enabled electrocardiogram: a pragmatic, cluster-randomized clinical trial.Nature medicine · 2026Trial
- Trial
- Evaluating the Diagnostic Potential of the FIB-4 Index for Cystic Fibrosis-Associated Liver Disease in Adults: A Comparison with Transient Elastography.Journal of clinical medicine · 2025Article
- Increasing engagement with liver disease management across the UK: a follow-up cross-sectional survey.BJGP open · 2025Article
- Screening high-risk Veterans for cirrhosis: taking a stepwise population health approach.BMC health services research · 2025Article
- Characterization of an At-Risk Population for Nonalcoholic Fatty Liver Disease (NAFLD) in a Primary Care Setting Along the U.S.-Mexico Border.Journal of transcultural nursing : official journal of the Transcultural Nursing Society · 2025Review
- Interpreting elevated liver blood test results through a genetic lens: A genome-wide association study.Liver international : official journal of the International Association for the Study of the Liver · 2024Article
- An Assessment of the Feasibility, Patient Acceptance, and Performance of Point-of-Care Transient Elastography for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis.Diagnostics (Basel, Switzerland) · 2024Review
- Diagnostic and prognostic performance of the LiverRisk score in tertiary care.JHEP reports : innovation in hepatology · 2024Article
- Missed and Delayed Diagnoses of Chronic Liver Disease in Primary Care Patients with Cirrhosis.Digestive diseases and sciences · 2024Article
- Palm-Sized Wireless Transient Elastography System with Real-Time B-Mode Ultrasound Imaging Guidance: Toward Point-of-Care Liver Fibrosis Assessment.Diagnostics (Basel, Switzerland) · 2024Article
- Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services.JMIR formative research · 2023Article
- Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD): an open-label pragmatic feasibility randomised controlled trial.EClinicalMedicine · 2023Article
- Evaluation of risk factors for non-alcoholic fatty liver disease in India: A systematic review and meta-analysis.Journal of education and health promotion · 2023Article
- Comparison of various strategies to define the optimal target population for liver fibrosis screening: A population-based cohort study.United European gastroenterology journal · 2022Article
- Accuracy of FIB-4 to Detect Elevated Liver Stiffness Measurements in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study in Referral Centers.International journal of molecular sciences · 2022Article
- Artificial intelligence outperforms standard blood-based scores in identifying liver fibrosis patients in primary care.Scientific reports · 2022Article
- Transient Elastography in Community Alcohol Services: Can It Detect Significant Liver Disease and Impact Drinking Behaviour?Biomedicines · 2022Article
- Health Technology Adoption in Liver Disease: Innovative Use of Data Science Solutions for Early Disease Detection.Frontiers in digital health · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the feasibility of a novel diagnostic algorithm targeting patients with risk factors for chronic liver disease in a community setting.
designProspective cross-sectional study.
settingTwo primary care practices (adult patient population 10,479) in Nottingham, UK.
participantsAdult patients (aged 18 years or over) fulfilling one or more selected risk factors for developing chronic liver disease: (1) hazardous alcohol use, (2) type 2 diabetes or (3) persistently elevated alanine aminotransferase (ALT) liver function enzyme with negative serology.
interventionsA serial biomarker algorithm, using a simple blood-based marker (aspartate aminotransferase:ALT ratio for hazardous alcohol users, BARD score for other risk groups) and subsequently liver stiffness measurement using transient elastography (TE).
main outcome measuresDiagnosis of clinically significant liver disease (defined as liver stiffness ≥8 kPa); definitive diagnosis of liver cirrhosis.
resultsWe identified 920 patients with the defined risk factors of whom 504 patients agreed to undergo investigation. A normal blood biomarker was found in 62 patients (12.3%) who required no further investigation. Subsequently, 378 patients agreed to undergo TE, of whom 98 (26.8% of valid scans) had elevated liver stiffness. Importantly, 71/98 (72.4%) patients with elevated liver stiffness had normal liver enzymes and would be missed by traditional investigation algorithms. We identified 11 new patients with definite cirrhosis, representing a 140% increase in the number of diagnosed cases in this population.
conclusionsA non-invasive liver investigation algorithm based in a community setting is feasible to implement. Targeting risk factors using a non-invasive biomarker approach identified a substantial number of patients with previously undetected cirrhosis. TRIAL REGISTRATION NUMBER: The diagnostic algorithm utilised for this study can be found on clinicaltrials.gov (NCT02037867), and is part of a continuing longitudinal cohort study.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.