P211 Alcohol use disorders and liver fibrosis – cases are missed through failure to test

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Background and Aims Alcohol Use Disorders (AUD) account for 7.2% hospital admissions per year in the UK. While a proportion of these people are recognised to have liver disease and are managed by liver specialists, many are managed by a wide range of physicians and their liver disease may be missed even if their AUD is recognised. We aimed to use non-invasive tests for liver fibrosis to investigate the prevalence of occult liver disease in patients recognised to have AUD but not known to have liver disease. Methods Prospective service evaluation of liver fibrosis in consecutive patients referred to the Alcohol Specialist Nurse (ASN) at the Royal Free Hospital from Nov’ 2018-Dec’ 2019. Patients were excluded if they were already known to have liver disease. Liver fibrosis was assessed using the Enhanced Liver Fibrosis (ELF) test performed on serum extracted from 5 ml of blood, analysed on an Advia Centuar. Patient demographic, blood test and imaging data were recorded along with alcohol histories. Patients with ELF scores ≥10.5 were invited for fibroscans and outpatient hepatology assessments. Results We included 100 patients (69% male, mean age 53.15 ± 14.3). Median alcohol intake was 140 units/week (IQR 79.1–280), with duration of excess alcohol of 15 years (IQR 10–29). The commonest reason for presentation to hospital was symptomatic alcohol withdrawal (n=36/100). Other reasons included falls/trauma (13%), pancreatitis (9%), mental health (12%), GI bleed (5%) and ‘other’ (25%). None had a prior history of liver disease. Four patients had documented signs of CLD. Liver function tests, checked in 96/100 patients were abnormal in 64/96 (64%). ELF scores ranged from 6.87–13.78, median 9.66 (IQR 8.94–10.6). Of the total cohort, 29/100 (29%) had an ELF score ≥10.5. Of these, 29.6% had normal LFTs. 76% had previously attended A&E in the last 5 years, (median number of presentations = 4, IQR 2–9) without assessment or diagnosis of liver disease. Conclusion Over a quarter of patients in this cohort with AUD had evidence of advanced liver fibrosis that had been undetected prior to ‘opportunistic’ ELF testing. The vast majority had had recent hospital attendances representing additional missed opportunities for investigating liver disease. LFTs cannot be relied upon to for detection of liver disease in AUD. We propose that clinicians consider using non-invasive tests to assess liver fibrosis in all patients admitted to hospital with AUD.

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