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Screening for alcohol-related liver damage in the community: findings from the PrevAIL (Preventing Alcohol Harm in Liverpool) Study

Progression of alcohol-related liver fibrosis stops when drinking stops, but the diagnosis is usually missed because the process of fibrosis is symptom free and missed by the usual liver function tests. Non-invasive tests to detect fibrosis and cirrhosis are available, but not currently used in primary care. We aimed to: identify optimal ways of engaging communities with liver disease screening; to inform a future trial to augment brief interventions with a liver risk score; and to estimate the prevalence of liver disease. Participants, aged 36-55y, registered with general practice (GP) or working in Merseyside, UK, were contacted by post (GP) or through workplaces. Risky drinkers (previous week drinking >112g females/168g males) were invited for a liver screen. Blood samples were tested for fibrosis markers (hyaluronic acid and procollagen type III N-terminal peptide) and categorised using the Simple Traffic Light (STL) algorithm. Of 6439 GP registrants, 539 (8%) returned the alcohol consumption questionnaire; 152 were risky drinkers and were invited for liver screening, and 27 attended. Screening in the 13 participating workplaces (out of 37 approached) was attended by 2-6% of the eligible workforce (n=363). Of 142 risky drinkers, most (91%) accepted the liver screening test. In total, seven samples were graded ‘red’, yielding a prevalence of 4.6% (95%CI 2.02—9.14%) of probable liver disease and further 26.3% (20.0—33.7%; 41 samples) scored ‘amber’ (moderate risk). Detecting and supporting cases in the community could avert deaths and save costs, and this work informs development of a trial to determine whether feedback of liver disease risk scores is more effective than brief intervention alone. We conclude that workplaces are optimum sites, because screening takes place at a time and location that was convenient for participants; however alternative methods will be required to access those who do not work, whose risk may be higher.

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Correspondence to Penny A Cook.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cook, P.A., Morleo, M., Billington, D. et al. Screening for alcohol-related liver damage in the community: findings from the PrevAIL (Preventing Alcohol Harm in Liverpool) Study. Addict Sci Clin Pract 8 (Suppl 1), A18 (2013).

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