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Health outcomes following liver function testing in primary care: a retrospective cohort study

Health outcomes following liver function testing in primary care: a retrospective cohort study
Health outcomes following liver function testing in primary care: a retrospective cohort study
Background: patients who present with abnormal liver function tests (LFTs) in primary care and no obvious symptoms can be difficult to manage.
Objective: the objective is to follow-up a cohort of liver function tested patients to determine their outcome.
Methods: this population-based retrospective cohort study was conducted in Tayside, Scotland, from 1989 to 2003. Subjects were patients with no clinically obvious liver disease at initial liver function testing in primary care. Main outcomes were diagnosed liver disease and mortality. Record linkage of databases ascertained risk factors and outcomes. Measures of performance were calculated and Weibull regression analysis from initial LFT date was performed on all outcomes by level of abnormality.
Results: in total, 95 977 patients had 364 194 incident initial LFTs, with median follow-up 3.7 years. A total of 21.7% had at least one abnormal LFT and 1108 (1.15%) developed liver disease. Elevated transaminase was strongly associated with diagnosed liver disease, hazard ratio (HR) = 4.23 (95% confidence interval 3.55, 5.04) for mild levels and HR = 12.67 (95% CI 9.74, 16.47) for severe levels versus normal. For gamma-glutamyl transferase, these hazards were 2.54 (95% CI 2.17, 2.96) and 13.44 (95% CI 10.71, 16.87), respectively. Low albumin was strongly associated with all-cause mortality, HR = 2.65 (95% CI 2.47, 2.85) for mild levels and HR = 4.99 (95% CI 4.26, 5.84) for severe levels. Sensitivity for predicting events over 5 years was low and specificity high.
Conclusions: all LFTs were predictive markers for liver disease as well as general ill health, although sensitivity was poor. Most patients with abnormal LFTs had no later formal diagnosis of liver disease within the study period. The time taken to develop liver disease in these patients provides opportunity to intervene
liver disease, liver function tests, mortality, sensitivity, survival
0263-2136
251-9
McLernon, David J.
efe3567f-dea6-47ba-9d20-4cdd1739c8df
Donnan, Peter T.
d0e68025-e8d8-4b3a-899f-4330ef30d77d
Ryder, Stephen
7d252d42-2744-466d-83e5-91a6ea0bb0c8
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Sullivan, Frank M.
b20f056e-d03a-4adb-87f9-69a079872689
Rosenberg, William
cea47565-06a3-4622-931c-aa5a7686865c
Dillon, John F.
20705ee1-dc06-4334-8e1a-60fc7fb5bf1d
McLernon, David J.
efe3567f-dea6-47ba-9d20-4cdd1739c8df
Donnan, Peter T.
d0e68025-e8d8-4b3a-899f-4330ef30d77d
Ryder, Stephen
7d252d42-2744-466d-83e5-91a6ea0bb0c8
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Sullivan, Frank M.
b20f056e-d03a-4adb-87f9-69a079872689
Rosenberg, William
cea47565-06a3-4622-931c-aa5a7686865c
Dillon, John F.
20705ee1-dc06-4334-8e1a-60fc7fb5bf1d

McLernon, David J., Donnan, Peter T., Ryder, Stephen, Roderick, Paul, Sullivan, Frank M., Rosenberg, William and Dillon, John F. (2009) Health outcomes following liver function testing in primary care: a retrospective cohort study. Family Practice, 26 (4), 251-9. (doi:10.1093/fampra/cmp025).

Record type: Article

Abstract

Background: patients who present with abnormal liver function tests (LFTs) in primary care and no obvious symptoms can be difficult to manage.
Objective: the objective is to follow-up a cohort of liver function tested patients to determine their outcome.
Methods: this population-based retrospective cohort study was conducted in Tayside, Scotland, from 1989 to 2003. Subjects were patients with no clinically obvious liver disease at initial liver function testing in primary care. Main outcomes were diagnosed liver disease and mortality. Record linkage of databases ascertained risk factors and outcomes. Measures of performance were calculated and Weibull regression analysis from initial LFT date was performed on all outcomes by level of abnormality.
Results: in total, 95 977 patients had 364 194 incident initial LFTs, with median follow-up 3.7 years. A total of 21.7% had at least one abnormal LFT and 1108 (1.15%) developed liver disease. Elevated transaminase was strongly associated with diagnosed liver disease, hazard ratio (HR) = 4.23 (95% confidence interval 3.55, 5.04) for mild levels and HR = 12.67 (95% CI 9.74, 16.47) for severe levels versus normal. For gamma-glutamyl transferase, these hazards were 2.54 (95% CI 2.17, 2.96) and 13.44 (95% CI 10.71, 16.87), respectively. Low albumin was strongly associated with all-cause mortality, HR = 2.65 (95% CI 2.47, 2.85) for mild levels and HR = 4.99 (95% CI 4.26, 5.84) for severe levels. Sensitivity for predicting events over 5 years was low and specificity high.
Conclusions: all LFTs were predictive markers for liver disease as well as general ill health, although sensitivity was poor. Most patients with abnormal LFTs had no later formal diagnosis of liver disease within the study period. The time taken to develop liver disease in these patients provides opportunity to intervene

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More information

Published date: August 2009
Keywords: liver disease, liver function tests, mortality, sensitivity, survival

Identifiers

Local EPrints ID: 72927
URI: http://eprints.soton.ac.uk/id/eprint/72927
ISSN: 0263-2136
PURE UUID: 87647eba-5832-4abb-905f-b2786c40d374
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 25 Feb 2010
Last modified: 14 Mar 2024 02:38

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Contributors

Author: David J. McLernon
Author: Peter T. Donnan
Author: Stephen Ryder
Author: Paul Roderick ORCID iD
Author: Frank M. Sullivan
Author: William Rosenberg
Author: John F. Dillon

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