ArticleBMJ open2013
What is the best strategy for investigating abnormal liver function tests in primary care? Implications from a prospective study.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 31 citations in OpenAlex.
- Comparison of serum alkaline phosphatase levels between two measurement methods in chronic hemodialysis patients in Japan: involvement of ABO blood group system and relationship with mortality risk.Clinical and experimental nephrology · 2024Article
- [Clarification of increased liver values in primary care - Findings from a series of studies from a general practitioner and specialist perspective].Zeitschrift fur Gastroenterologie · 2023Review
- Evaluation of elevated liver values in primary care - a series of studies on the status quo of care in Germany with special reference to alcoholic liver disease.BMC primary care · 2022Review
- Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis.World journal of gastrointestinal pathophysiology · 2021Article
- When Do Clinicians Follow-up Abnormal Liver Tests in Primary Care?The American journal of the medical sciences · 2019Article
- Towards better diagnostic tools for liver injury in low-income and middle-income countries.BMJ global health · 2019Review
- Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter?Journal of investigative medicine : the official publication of the American Federation for Clinical Research · 2018Article
- Reducing liver function tests for statin monitoring: an observational comparison of two clinical commissioning groups.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Observational
- Appropriate pathology ordering? Troponin testing within an Australian Emergency Department.Irish journal of medical science · 2017Article
- Review and Recommendations for the Component Tests in the Liver Function Test Profile.Indian journal of clinical biochemistry : IJCB · 2016Review
- Interaction of genetic markers associated with serum alkaline phosphatase levels in the Japanese population.Human genome variation · 2015Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveEvaluation of predictive value of liver function tests (LFTs) for the detection of liver-related disease in primary care.
designA prospective observational study.
setting11 UK primary care practices.
participantsPatients (n=1290) with an abnormal eight-panel LFT (but no previously diagnosed liver disease).
main outcome measuresPatients were investigated by recording clinical features, and repeating LFTs, specific tests for individual liver diseases, and abdominal ultrasound scan. Patients were characterised as having: hepatocellular disease; biliary disease; tumours of the hepato-biliary system and none of the above. The relationship between LFT results and disease categories was evaluated by stepwise regression and logistic discrimination, with adjustment for demographic and clinical factors. True and False Positives generated by all possible LFT combinations were compared with a view towards optimising the choice of analytes in the routine LFT panel.
resultsRegression methods showed that alanine aminotransferase (ALT) was associated with hepatocellular disease (32 patients), while alkaline phosphatase (ALP) was associated with biliary disease (12 patients) and tumours of the hepatobiliary system (9 patients). A restricted panel of ALT and ALP was an efficient choice of analytes, comparing favourably with the complete panel of eight analytes, provided that 48 False Positives can be tolerated to obtain one additional True Positive. Repeating a complete panel in response to an abnormal reading is not the optimal strategy.
conclusionsThe LFT panel can be restricted to ALT and ALP when the purpose of testing is to exclude liver disease in primary care.
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