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Title: Chronic liver disease detection and quantification
Author: Trembling, Paul Martin
ISNI:       0000 0004 7964 9071
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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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.
Supervisor: Rosenberg, W. ; Menon, U. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available