Sree Gokulam Medical College Trivandrum, Kerala, India
Introduction: Population based preventive hepatology strategy using using transient elastography has not been evaluated in S India and hence we evaluated the utility of transient elastography (TE) in the primary care setting and the determinants for liver stiffness
Methods: Study was undertaken in Kerala, which has the highest literacy, and a diverse population in relation to diet, ethnicity and religion. The study was community-based, and included the 12 blocks with 78 panchayats in the rural area, and the 81 wards in the urban corporation area. We adopted a multistage cluster sampling to enroll the study participants.12505 participants were eventually recruited by a field team, through house to-house survey. The study was approved by the ethical committee of Sree Gokulam Medical College. We calculated descriptive statistics of demographic characteristics for the study population, including age, sex, BMI, residential area, religion, the status of pan masala chewing and cigarette smoking, alcohol intake, . Liver stiffness was assessed by fibroscan ( ECHOsens ). Logistic regression model was used to obtain odds ratio (ORs) with 95 % confidence intervals (CIs) for potential risk factors in relation to the presence of higher liver stiffness (7.2 or greater ). A p-value of < 0.05 is considered statistically significant. All statistical analyses were done by SPSS statistical software.
Results: 5931 were males and 6574 were females. 3131(25.03 %) had high liver stiffness (7.2 or greater ).and 1183 ( 9.46% ) had stiffness of more than 9.2. . Liver stiffness (mean ± sd) was 7.5± 5.6 in males and 6.29 ± 3.7 among females and !Q range was 5.1 to 7.3 and 4.5 to 6.9 respectively. 3131 had a median stiffness of 7.2 or more and men accounted for 56.53 % ; higher median stiffness was in the rural domicile, those with a BMI of greater than 23( p< 0.001) . 22..5% had diabetes in this cohort and those with diabetes mellitus , hypertension and ischemic heart disease, any previous liver disease such as NAFLD had higher liver stiffnees ( p< 0.001) . Coffee intake was seen in 11.1% of those with higher liver stiffness but not significant. In the multivariate logistic regression model, age greater than 60,rural domicile, male sex , BMI greater than 23 , alcohol abuse, diabetes mellitus, and any previous disease are independent risk factors for higher liver stiffness of 7.2 and above
Discussion: High degree of liver stiffness in our population needs intervention strategies and follow up.
