背景:患有代偿性肝硬化的人从危险因素修改和预防计划中获得最大的益处,以减少肝脏代偿失调并改善早期肝癌的检测。基于血液的肝纤维化算法,如天冬氨酸转氨酶与血小板比率指数(APRI)和纤维化-4(FIB-4)指数是使用常规血液测试计算的,并且是有效的筛查测试,以排除慢性肝病患者的肝硬化。对进一步调查以确认肝硬化和与专科护理的联系的必要性进行分类。
目的:这项初步研究旨在评估肝硬化人群筛查计划的影响(CAPRISE[肝硬化自动APRI和FIB-4筛查评估]),它使用自动APRI和FIB-4计算并报告常规血液检查,关于瞬时弹性成像的每月转诊率,肝硬化诊断,以及与专科护理的联系。
方法:我们与维多利亚州的一家大型病理服务机构合作,澳大利亚,试点人群水平的肝硬化筛查方案,包括(1)自动计算和报告常规血液检查的APRI和FIB-4;(2)提供关于肝硬化的简要信息;和(3)瞬时弹性成像转诊的网络链接。APRI和FIB-4将根据参加单一病理服务的成年人的所有社区有序病理结果进行前瞻性计算。这个单一中心,prospective,单臂,研究前将比较瞬时弹性成像(FibroScan)转诊的月率,肝硬化诊断,以及干预后6个月至干预前6个月与专科护理相关的比例。
结果:截至2024年1月,在本研究的干预前阶段,实验室共进行了120,972项测试。在这些测试中,排除了78,947(65.3%)测试,其余42,025(34.7%)对37,872名个人进行的测试符合纳入标准,可以计算APRI和FIB-4。在这42,025项测试中,1.3%(n=531)的446例患者APRI升高>1,2.3%(n=985)的816例患者FIB-4升高>2.67。将这些数据与FibroScan转诊和预约出勤联系正在进行中,并将在干预阶段继续进行,预计将于2024年2月1日开始。
结论:我们将确定自动APRI和FIB-4报告瞬时弹性成像转诊率的可行性和有效性,肝硬化诊断,以及与专科护理的联系。
背景:澳大利亚新西兰临床试验注册中心ACTRN12623000295640;https://tinyurl.com/58dv9ypp。
■DERR1-10.2196/56607。
BACKGROUND: People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care.
OBJECTIVE: This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care.
METHODS: We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention.
RESULTS: As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3%) tests were excluded, with the remaining 42,025 (34.7%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024.
CONCLUSIONS: We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care.
BACKGROUND: Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp.
UNASSIGNED: DERR1-10.2196/56607.