Using transient elastography to detect chronic liver diseases in a primary care nurse consultancy
Núria Fabrellas1, Magda Alemany, Marta Urquizu
1Núria Fabrellas, PhD, BA (hons), BSc, RN, is Professor of Nursing, School of Nursing, University of Barcelona, Institut d´Investigació Biomédica de Bellvitge (IDIBELL), Catalonia, Spain. Magda Alemany, RN, is Primary Care Nurse; and Marta Urquizu, RN, is Primary Care Nurse, Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d ´Investigació en Atenció Primária Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Spain. Concepció Bartres, RN, is Nurse Specialist, Liver Unit, Unitat Funcional Hepatitis, Hospital Clínic, Barcelona, Catalonia, Spain. Guillem Pera, MSc, is Statistician of the Research Support Unit, Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d´Investigació en Atencio´ Primária Jordi Gol (IDIAP Jordi Gol), Santa Coloma de Gramenet, Spain and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain. Eulália Juvé, PhD, MSN, RN, is Associate Professor of Nursing, School of Nursing, University of Barcelona, IDIBELL, Catalonia, Spain and Institut Catalá de la Salut, Catalonia, Spain. Lluís Rodríguez, PhD, is General Practitioner; Pere Toràn, PhD, is Research Support Unit Coordinator; Llorenç Caballería, PhD, MD, is Coordinator of the Research Unit on Liver Diseases, Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain and CIBERehd, Barcelona, Catalonia, Spain.
Background:
Chronic liver diseases (CLDs) are significant causes of death in adults in many countries and are usually diagnosed at late stages. Early detection may allow time for treatment to prevent disease progression.
Objectives:
The aim of this study was to assess the feasibility of screening for unrecognized CLDs in a primary care nurse consultancy and report findings from screening.
Methods:
Two experienced nurses in a primary care nurse consultancy were trained to perform transient elastography (TE). Subjects aged from 18 to 70 years were identified randomly from the health registry and invited to participate in a feasibility pilot study. Exclusion criteria were past or current history of liver diseases. Nurses collected demographic and clinical data and performed TE tests using Fibroscan to measure liver stiffness; a cutoff score of 6.8 kPa or greater was used as an indicator of the presence of CLD with fibrosis.
Results:
Accurate measurements were obtained in 495 of 502 participants (98.6%). Prevalence of elevated liver stiffness was observed in 28 of 495 subjects (5.7%). Compared to patients with normal liver stiffness, patients with increased liver stiffness were older, were more frequently male, and had higher frequency of metabolic syndrome. Nonalcoholic fatty liver was the most common cause of CLD.
Discussion:
Following training in procedures for conducting TE, nurses in a primary care clinic were able to detect unrecognized CLDs in presumably healthy subjects. Early detection of CLDs is feasible in primary care clinics and may facilitate identification of undiagnosed CLD in adults.
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