The growing burden of alcohol-related liver disease (ARLD) could be reduced if hospitals introduced a simple universal screening procedure for those attending acute and emergency hospital settings, according to a new study shared today at The International Liver Congress™ in Barcelona, Spain.
Knowing that those at risk of alcohol related harm are often frequently admitted to emergency care settings, the UK researchers examined the feasibility of screening all acute care admissions for alcohol misuse. They found that not only is universal screening readily achievable, but it identifies patients who are at greatest risk of alcohol-related harm at a point when they can be targeted for treatment, thus reducing the risk of more severe liver damage.
According to the World Health Organization, Europe is the heaviest drinking region in the world in terms of the prevalence of alcohol consumption.1 Alcohol is also the main cause of liver disease, including liver cirrhosis which accounts for 1.8% of all deaths in Europe or around 170,000 deaths per year.2
Study author, Dr Richard Aspinall, consultant hepatologist from Portsmouth Hospitals NHS Trust, UK commented: "Many who die from cirrhosis due to alcohol related harm have a history of recurrent hospital admissions, meaning we are missing chances to offer treatment. This study shows that universal screening for alcohol misuse among patients admitted to Acute Medical Units is both achievable and can help inform targeted interventions. By classifying these patients according to their risk of alcohol harm, we can ensure they received the appropriate treatments to reduce the risk of adverse events occurring in the future, thus reducing the healthcare burden of alcohol-related harm."
Between July 2011 and March 2014, researchers collected data from over 53,000 admissions to the Acute Medical Unit of a major UK hospital. Patients were grouped according to their risk of alcohol-related harm, with 1,122 classified at 'increasing' risk, 1,921 classified at 'high' risk and the remainder classified as 'lower' risk. Information was collected on admission diagnoses, alcohol unit consumption, previous attendances, previous admissions, length of stay and mortality. Screening enabled the identification of a cohort of patients with frequent emergency department attendances, recurrent admissions and elevated risk of ARLD. Patients at 'increasing' risk of alcohol-related harm were referred for either a brief intervention or further assessment by an Alcohol Specialist Nurse Service.
Professor Laurent Castera, EASL Secretary General, commented, "This study places a spotlight on the significant burden alcohol misuse poses to health services, and the potential benefit of screening in reducing this burden." He continued, "Providing interventions for those at high risk of alcohol harm is vital. Creating a culture supportive of healthy behavioral change to help reduce alcohol consumption in Europe is however, equally as important if we are to address the root cause of this problem."
Acute Medical Unit
An Acute Medical Unit (AMU) is the first point of entry for patients requiring admission from the Emergency Department and those referred to hospitals as emergencies by their doctor.
Alcohol-related liver disease (ARLD)
Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. Usually ARLD does not present with any symptoms until the liver has been severely damaged. There are several stages of severity and symptoms can include feeling sick, weight loss, loss of appetite, yellowing of the eyes and skin (jaundice), swelling in the ankles and tummy, confusion or drowsiness and vomiting blood or passing blood in your stools. ARLD is often diagnosed during tests for other conditions, or at a stage of advanced liver damage.4
Materials provided by European Association for the Study of the Liver. Note: Content may be edited for style and length.
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