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Most are not managed by hepatologists and liver disease may be missed. We used the Enhanced Liver Fibrosis (ELF) test to investigate prevalence and associations of occult advanced liver fibrosis in AUD patients not known to have liver fibrosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Liver fibrosis was assessed using ELF in prospective patients referred to the Royal Free Hospital Alcohol Specialist Nurse (November 2018\u2013December 2019). Known cases of liver disease were excluded. Patient demographics, blood tests, imaging data and alcohol histories recorded. Advanced fibrosis was categorised as ELF\u2009\u2265\u200910.5.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The study included 99 patients (69% male, mean age 53.1\u2009\u00b1\u200914.4) with median alcohol intake 140 units\/week (IQR 80.9\u2013280), and a mean duration of harmful drinking of 15\u00a0years (IQR 10\u201327.5). The commonest reason for admission was symptomatic alcohol withdrawal (36%). The median ELF score was 9.62, range 6.87\u201313.78. An ELF score\u2009\u2265\u200910.5 was recorded in 28\/99 (29%) patients, of whom 28.6% had normal liver tests. Within previous 5-years, 76% had attended A&amp;E without assessment of liver disease. The ELF score was not associated with recent alcohol intake (<jats:italic>p<\/jats:italic>\u2009=\u20090.081), or inflammation (<jats:italic>p<\/jats:italic>\u2009=\u20090.574).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Over a quarter of patients with AUD had previously undetected advanced liver fibrosis assessed by ELF testing. ELF was not associated with liver inflammation or recent alcohol intake. The majority had recent missed opportunities for investigating liver disease. We recommend clinicians use non-invasive tests to assess liver fibrosis in patients admitted to hospital with AUD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-01728-2","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T09:02:43Z","timestamp":1617181363000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Uncovering unsuspected advanced liver fibrosis in patients referred to alcohol nurse specialists using the ELF test"],"prefix":"10.1186","volume":"21","author":[{"given":"Freya","family":"Rhodes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Cococcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmina","family":"Panovska-Griffiths","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudeep","family":"Tanwar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel H.","family":"Westbrook","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Rodger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-2304","authenticated-orcid":false,"given":"William M.","family":"Rosenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"1728_CR1","unstructured":"British-Liver-Trust. 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Using the Health Research Authority Tool () the study did not meet the criteria that would require it to undergo external ethical review but rather to be registered as a service evaluation conducted within the NHS Trust. It was registered with the Royal Free London Audit and Service Evaluation Department on the 10<sup>th<\/sup> October 2018. Based on this review of the study the Royal Free London NHS Foundation Trust Research and Development Office deemed that there was no necessity to obtain informed consent from participants in this service evaluation. Although not deemed to be \u201cresearch\u201d using the HRA Tool, the study was in compliance with the regulatory requirements for service evaluations and was conducted in accordance with the principles of the WMA Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"WMR is an inventor of the ELF test but receives no related royalties. WMR has received speaker\u2019s fees from Siemens Healthineers. The other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"143"}}