Trembling, Paul Martin;
(2019)
Chronic liver disease detection and quantification.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Chronic liver disease (CLD) is a major cause of death in the UK. The major contributors are alcohol, fat and viral hepatitis. The common pathway towards cirrhosis is progressive liver fibrosis. The utility of the traditional method of evaluating fibrosis, liver biopsy, is limited by procedural risk, sampling error and variability in histological analysis. This has driven exploration of non-invasive markers of liver fibrosis. I evaluated the performance of the Enhanced Liver Fibrosis (ELF) test to detect liver fibrosis in chronic hepatitis B and compared it to an alternative modality, transient elastography (TE), demonstrating good diagnostic performance in fibrosis assessment, with comparable performance to TE. Further, liver biopsy is not feasible in community settings, and although the role of non-invasive markers of fibrosis is expanding, they have not been widely evaluated in community settings. I estimated the incidence of CLD in a large cohort of community-based postmenopausal women and investigated the contribution of alcohol and overweight / obesity to risk of CLD, observing more clinical events attributable to cirrhosis among those who were overweight or obese, with the highest risk in those who were overweight or obese consuming the most alcohol. I estimated the association between skirt size, as a surrogate for overweight / obesity, and CLD, finding significantly increased risk in those with larger or increasing skirt size. I demonstrated that the ELF test predicts CLD in women with risk factors comprising alcohol excess and / or overweight or obesity. In addition to contributing to the epidemiological data in postmenopausal women, an important but under-evaluated group in terms of liver disease, I have provided data that could be used to design pathways for the early detection and stratification of CLD in the community.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Chronic liver disease detection and quantification |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10070378 |
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