Karl Trygve Druckrey-Fiskaaen
Trained as a medical doctor I have been working with addiction medicine since 2010. In 2016, I became a specialist in addiction medicine in Norway and has since been working as a consultant in in-patient addiction wards at the university hospital of Bergen, Norway. For the past years, my fields of interest have been in-patient detoxification/ withdrawal treatment of patients as well as in-patient treatment following detoxification. In the fall of 2020, I started my PhD training focusing on liver and pulmonary health among patients on opioid maintenance treatment.
Liver disease in a prospective cohort of patient with substance use disorders
Aims Investigating the prevalence and time trend of liver disease among patients with substance use disorders.
Design Prospective cohort study nested to a randomized controlled trial.
Setting Outpatient clinics for opioid agonist treatment in Norwegian cities of Bergen and Stavanger and municipal low-threshold clinics for persons with substance use disorders in Bergen.
Participants 661 patients of which 298 persons had two measurements
Intervention Yearly health evaluation including blood-sampling and transient elastography
Measurements Liver stiffness Hepatitis C infection status Self-reported alcohol use
Findings Liver stiffness measurements at baseline: 502 patients (76%) with liver stiffness < 7 kilopascal indicating no fibrosis 160 patients (26%) with liver stiffness between 7 and 12.5 kilopascal indicating fibrosis 50 patients (8%) with liver stiffness > 12.5 kilopascal indicating cirrhosis 160 patients (26%) reported drinking alcohol frequently. Almost half of the patients (N=309) had an active hepatitis C infection with virus replication at baseline Linear mixed model analysis indicated that hepatitis C infection with RNA replication increased liver stiffness by 1.3 kilopascal (95 % confidence interval 0.41 – 2.2) at baseline. Adopting a frequent use of alcohol increased liver stiffness by 4.2 kilopascal (95 % confidence interval 2.0 – 6.4) per year.
Conclusions A third of the patients had liver fibrosis or cirrhosis Alcohol and hepatitis C infection were the most important risk factors for increased liver stiffness Addressing alcohol use at opioid agonist clinics is of clinical importance.