Highlights
- •Intelligent liver function testing utilises the smarter application of existing knowledge and technology.
- •Intelligent liver function testing increases diagnosis of liver disease by 43%, with diagnostic accuracy over 90%.
- •Intelligent liver function testing enables earlier identification of treatable liver disease.
Background & Aims
Liver function tests (LFTs) are frequently requested blood tests which may indicate
liver disease. LFTs are commonly abnormal, the causes of which can be complex and
are frequently under investigated. This can lead to missed opportunities to diagnose
and treat liver disease at an early stage. We developed an automated investigation
algorithm, intelligent liver function testing (iLFT), with the aim of increasing the
early diagnosis of liver disease in a cost-effective manner.
Methods
We developed an automated system that further investigated abnormal LFTs on initial
testing samples to generate a probable diagnosis and management plan. We integrated
this automated investigation algorithm into the laboratory management system, based
on minimal diagnostic criteria, liver fibrosis estimation, and reflex testing for
causes of liver disease. This algorithm then generated a diagnosis and/or management
plan. A stepped-wedged trial design was utilised to compare LFT outcomes in general
practices in the 6 months before and after introduction of the iLFT system. Diagnostic
outcomes were collated and compared.
Results
Of eligible patients with abnormal LFTs, 490 were recruited to the control group and
64 were recruited to the intervention group. The primary diagnostic outcome was based
on the general practitioner diagnosis, which agreed with the iLFT diagnosis in 67%
of cases. In the iLFT group, the diagnosis of liver disease was increased by 43%.
Additionally, there were significant increases in the rates of GP visits after diagnosis
and the number of referrals to secondary care in the iLFT group. iLFT was cost-effective
with a low initial incremental cost-effectiveness ratio of £284 per correct diagnosis,
and a saving to the NHS of £3,216 per patient lifetime.
Conclusions
iLFT increases liver disease diagnoses, improves quality of care, and is highly cost-effective.
This can be achieved with minor changes to working practices and exploitation of functionality
existing within modern laboratory diagnostics systems.
Lay summary
There is a growing epidemic of advanced liver disease, this could be offset by early
detection and management. Checking liver blood tests (LFTs) should be an opportunity
to diagnose liver problems, but abnormal results are often incompletely investigated.
In this study we were able to substantially increase the diagnostic yield of the abnormal
LFTs using the automated intelligent LFT system. With the addition of referral recommendations
and management plans, this strategy provides optimum investigation and management
of LFTs and is cost saving to the NHS.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: June 18, 2019
Accepted:
May 18,
2019
Received in revised form:
May 10,
2019
Received:
September 4,
2018
See Editorial, pages 651–653Identification
Copyright
© 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
