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

D. J. McLernon, P. T. Donnan, S. Ryder, P. Roderick, F. M. Sullivan, W. Rosenberg, J. F. Dillon

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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.
Original languageEnglish
Pages (from-to)251-259
Number of pages9
JournalFamily Practice
Volume26
Issue number4
Early online date12 May 2009
DOIs
Publication statusPublished - May 2009

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Liver Function Tests
Liver Diseases
Primary Health Care
Cohort Studies
Retrospective Studies
Liver
Health
Mortality
Delayed Diagnosis
Scotland
Transferases
Transaminases
Albumins
Regression Analysis
Databases
Confidence Intervals
Population

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McLernon, D. J., Donnan, P. T., Ryder, S., Roderick, P., Sullivan, F. M., Rosenberg, W., & Dillon, J. F. (2009). Health outcomes following liver function testing in primary care: a retrospective cohort study. Family Practice, 26(4), 251-259. https://doi.org/10.1093/fampra/cmp025

Health outcomes following liver function testing in primary care : a retrospective cohort study. / McLernon, D. J.; Donnan, P. T.; Ryder, S.; Roderick, P.; Sullivan, F. M.; Rosenberg, W.; Dillon, J. F.

In: Family Practice, Vol. 26, No. 4, 05.2009, p. 251-259.

Research output: Contribution to journalArticle

McLernon, DJ, Donnan, PT, Ryder, S, Roderick, P, Sullivan, FM, Rosenberg, W & Dillon, JF 2009, 'Health outcomes following liver function testing in primary care: a retrospective cohort study' Family Practice, vol. 26, no. 4, pp. 251-259. https://doi.org/10.1093/fampra/cmp025
McLernon, D. J. ; Donnan, P. T. ; Ryder, S. ; Roderick, P. ; Sullivan, F. M. ; Rosenberg, W. ; Dillon, J. F. / Health outcomes following liver function testing in primary care : a retrospective cohort study. In: Family Practice. 2009 ; Vol. 26, No. 4. pp. 251-259.
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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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AU - McLernon, D. J.

AU - Donnan, P. T.

AU - Ryder, S.

AU - Roderick, P.

AU - Sullivan, F. M.

AU - Rosenberg, W.

AU - Dillon, J. F.

PY - 2009/5

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N2 - 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.

AB - 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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DO - 10.1093/fampra/cmp025

M3 - Article

VL - 26

SP - 251

EP - 259

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 4

ER -