The feasibility of liver biomarkers as prognostic markers in decompensated alcoholic liver disease (BANDED study)
1st September 2012
Alcoholic liver disease (ALD) is a growing health burden in the United Kingdom. Liver disease is now the fifth most common cause of death in the UK and, unlike the first four causes of death, the incidence is rising. Alcohol abstinence rates at one year in patients with established liver disease remain poor at 20-30%. The only available treatment for advanced scarring (cirrhosis) is liver transplantation. The UK performs approximately 600-700 liver transplants a year at a cost of £50,000 each. There remains a severe nationwide organ shortage for liver transplantation. Therefore a need exists for an accurate prognostic tool to select patients for this valuable resource, as well as novel approaches aiming to improve alcohol abstinence in this high risk group.
Fibroscan is a non invasive imaging investigation which measures liver stiffness, known to correlate well with advanced liver scarring (cirrhosis) on liver biopsy. Indocyanine green is an inert dye which is purely extracted from the blood by liver cells, and is hence an excellent marker of both liver cell function and overall liver blood flow. There is little data for either of these biomarkers regarding important outcomes in alcoholic liver disease.
We aim to establish the accuracy of these liver biomarkers in predicting important liver related outcomes (death, transplantation and hospital readmission with cirrhosis related consequences) in patients with severe (decompensated) alcoholic liver disease. Moreover, we will assess whether the serial measurement of biomarkers has any impact on alcohol abstinence, motivation or quality of life.
Over an 18 month period, 125 consecutive hospital inpatients with decompensated alcoholic liver disease will undergo baseline biomarker measurement, routine blood and urine tests and qualitative questionnaires (including assessment of current alcohol intake). These will be measured during their initial hospital admission (0 months) with subsequent repeat measurement during follow up visits at 1, 2, 4 and 6 months. The ability of the chosen biomarkers to predict death, need for liver transplantation and other consequences of cirrhosis will be calculated. The study started in September 2012.
|Dr Neil Guha||Dr Neil Guha is a Clinical Associate Professor in Hepatology at the University of Nottingham. He trained at Guy's and St. Thomas's hospitals and began his postgraduate career in hepatology at St. Mary's Hospital, London. His doctoral thesis, awarded by…|
|Professor Guruprasad Aithal||Professor Aithal has been a Consultant Hepatobiliary Physician at Nottingham University Hospitals NHS trust since 2001. He is the Lead Director of the NIHR Nottingham Digestive Diseases Biomedical Research Unit, and the Head of Division for the Nottingham…|