Number needed to screen to prevent progression of liver fibrosis to cirrhosis at primary health centers: An experience from Delhi

Bharathnag Nagappa; Archana Ramalingam; Aayushi Rastogi; Shantanu Dubey; Sherin Sarah Thomas; Ekta Gupta; Shiv Kumar Sarin

doi:10.4103/jfmpc.jfmpc_1441_20

Number needed to screen to prevent progression of liver fibrosis to cirrhosis at primary health centers: An experience from Delhi

J Family Med Prim Care. 2021 Mar;10(3):1412-1418. doi: 10.4103/jfmpc.jfmpc_1441_20. Epub 2021 Apr 8.

Authors

Bharathnag Nagappa¹, Archana Ramalingam¹, Aayushi Rastogi¹, Shantanu Dubey², Sherin Sarah Thomas³, Ekta Gupta⁴, Shiv Kumar Sarin⁵

Affiliations

¹ Department of Epidemiology, Institute of Liver and Biliary Sciences, Delhi, India.
² Assistant Head Operations (Medical), Institute of Liver and Biliary Sciences, Delhi, India.
³ Department of Biochemistry (Metabolic Medicine and Immunopathology), Institute of Liver and Biliary Sciences, Delhi, India.
⁴ Department of Virology, Institute of Liver and Biliary Sciences, Delhi, India.
⁵ Department of Hepatology and Director, Institute of Liver and Biliary Sciences, Delhi, India.

Abstract

Background: Early diagnosis has been a bottleneck in the care of chronic liver disease patients and can be addressed by Community-based screening for liver fibrosis using non-invasive diagnostic techniques.

Objectives: The study aimed to determine the prevalence of liver fibrosis and the number needed to screen (NNS) to prevent the progression of fibrosis, among adults visiting urban Primary Health Centres (PHC).

Methods: A facility-based cross-sectional study was conducted from May 2018 to April 2019 in 72 randomly chosen PHCs using a mobile screening van. A pre-tested questionnaire was used to collect relevant history from adult patients and patient attenders. A venous blood sample was collected for biochemical markers and Transient Elastography was also done to measure Liver stiffness (LSM). LSM ≥6.0 kPa was taken as the cut-off for detecting liver fibrosis. Lifestyle modifications and alcohol cessations were considered as interventions for non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) respectively, to calculate NNS.

Results: 7624 participants were recruited in the study with a mean age of 46 ± 12 years. Around 35.5% of participants had liver fibrosis and 3% had cirrhosis. Nearly 4% had ALD and 30% had NAFLD. NNS for preventing progression of fibrosis for ALD and NAFLD was 12 and 29 respectively. NNS was least among obese, diabetes and hypertensive participants.

Conclusion: One-third of adults visiting urban PHCs had significant liver fibrosis. Low NNS to prevent the progression of fibrosis to cirrhosis among alcohol users and other high-risk groups, substantiates the need for screening among these groups.

Keywords: Alcoholic liver disease; non-alcoholic fatty liver disease; number needed to screen; primary health care.