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Developing a 'traffic light' test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Developing a 'traffic light' test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community
Developing a 'traffic light' test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community
Background: Liver disease develops silently and presents late, with often fatal complications.

Aim: To develop a `traffic light' test for liver disease suitable for community use that could enhance assessment of liver risk and allow rational referral of more severe disease to specialist care.

Design and setting: Two cohorts from Southampton University Hospital Trust Liver Unit: model development and a validation cohort to evaluate prognosis.

Method: A total of 1038 consecutive liver patients (inpatient and outpatient) (development n = 397, validation n = 641) for whom the relevant blood tests had been performed, were followed for a mean of 46 months (range 13-89 months). Blood tests for: hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and platelet count were combined in a diagnostic algorithm to stage liver disease.

Results: A simple clinical rule combined: HA, P3NP, and platelet count into a `traffic light' algorithm, grading the results red - high risk, amber - intermediate risk, and green - low risk. In the validation cohort, no green subjects died or developed varices or ascites (n = 202); in the amber group, 9/267 (3.3%) died, 0/267 developed varices, and 2/267 (0.7%) developed ascites; in the red group, 24/172 died (14%), 24/172 (14%) developed varices, and 20/172 developed (11.6%) ascites. Survival was reduced in red (P<0.001) and amber (P<0.012) groups compared with green.

Conclusion: A simple blood test triages liver disease into three prognostic groups; used in the community, it could enhance the management of risk factors in primary care and rationalise secondary care referrals, including the many patients with fatty liver and relatively minor elevations in alanine transaminase.
cirrhosis, diagnosis, early diagnosis, liver diseases, liver fibrosis, primary care
0960-1643
e616-e624
Sheron, Nick
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Moore, Mike
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Ansett, Stacey
ba40fe3b-c669-4994-a59e-8d27f1d4ea37
Parsons, Camille
9730e5c3-0382-4ed7-8eaa-6932ab09ec15
Bateman, Adrian
35f5fef8-6358-42ff-b3c1-2ff226b4dc43
Sheron, Nick
cbf852e3-cfaa-43b2-ab99-a954d96069f1
Moore, Mike
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Ansett, Stacey
ba40fe3b-c669-4994-a59e-8d27f1d4ea37
Parsons, Camille
9730e5c3-0382-4ed7-8eaa-6932ab09ec15
Bateman, Adrian
35f5fef8-6358-42ff-b3c1-2ff226b4dc43

Sheron, Nick, Moore, Mike, Ansett, Stacey, Parsons, Camille and Bateman, Adrian (2012) Developing a 'traffic light' test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community. British Journal of General Practice, 62 (602), e616-e624. (doi:10.3399/bjgp12X654588). (PMID:22947582)

Record type: Article

Abstract

Background: Liver disease develops silently and presents late, with often fatal complications.

Aim: To develop a `traffic light' test for liver disease suitable for community use that could enhance assessment of liver risk and allow rational referral of more severe disease to specialist care.

Design and setting: Two cohorts from Southampton University Hospital Trust Liver Unit: model development and a validation cohort to evaluate prognosis.

Method: A total of 1038 consecutive liver patients (inpatient and outpatient) (development n = 397, validation n = 641) for whom the relevant blood tests had been performed, were followed for a mean of 46 months (range 13-89 months). Blood tests for: hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and platelet count were combined in a diagnostic algorithm to stage liver disease.

Results: A simple clinical rule combined: HA, P3NP, and platelet count into a `traffic light' algorithm, grading the results red - high risk, amber - intermediate risk, and green - low risk. In the validation cohort, no green subjects died or developed varices or ascites (n = 202); in the amber group, 9/267 (3.3%) died, 0/267 developed varices, and 2/267 (0.7%) developed ascites; in the red group, 24/172 died (14%), 24/172 (14%) developed varices, and 20/172 developed (11.6%) ascites. Survival was reduced in red (P<0.001) and amber (P<0.012) groups compared with green.

Conclusion: A simple blood test triages liver disease into three prognostic groups; used in the community, it could enhance the management of risk factors in primary care and rationalise secondary care referrals, including the many patients with fatty liver and relatively minor elevations in alanine transaminase.

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More information

Published date: September 2012
Keywords: cirrhosis, diagnosis, early diagnosis, liver diseases, liver fibrosis, primary care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 342864
URI: http://eprints.soton.ac.uk/id/eprint/342864
ISSN: 0960-1643
PURE UUID: 0bd21f25-cb75-446c-82cb-e179f5a335ae
ORCID for Nick Sheron: ORCID iD orcid.org/0000-0001-5232-8292
ORCID for Mike Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 17 Sep 2012 11:25
Last modified: 26 Nov 2021 02:49

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Contributors

Author: Nick Sheron ORCID iD
Author: Mike Moore ORCID iD
Author: Stacey Ansett
Author: Camille Parsons
Author: Adrian Bateman

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