Intelligent Testing Can Potentially Defuse the ‘Ticking Time Bomb’ of Liver Disease

Scientists from the University of Dundee and NHS Tayside in the UK have developed an Intelligent Liver Function test (iLFT) that can potentially detect liver disease in its early stages decades before it becomes fatal. The findings of this study were published in the Journal of Hepatology.

Liver disease, which clinicians call a ‘ticking time bomb’ is often asymptomatic and is one of the leading causes of death among people under the age of 65 in the UK. While liver function tests (LFTs) are frequently requested and may indicate the presence of liver disease, the tests often come back as abnormal, which can cause missed opportunities to detect and treat liver disease in its initial stages.

Researchers implemented a stepped-wedged trial design to compare the outcomes of LFT outcomes among General Practices in the UK six months prior and subsequent to the introduction of the iLFT system, which produced a diagnosis and/or management plan based on diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. The researcher’s algorithm was integrated into the laboratory management system, and all outcomes were aggregated and analyzed.

System Displays Diagnostic Accuracy

According to the results of the study, the use of iLFT lead to a 43% increase in the diagnosis of liver disease. Moreover, the algorithm exhibited a diagnostic accuracy rate of over 90%. “In looking at a large set of patient data from Tayside we noticed abnormal liver function tests popping up that were not fully investigated,” said Professor John Dillon, Consultant gastroenterologist and hepatologist, in a press release. Dr. Dillon was part of the team who developed the algorithm.

“All too often we were seeing patients dying of liver failure who had abnormal Liver Function Tests recorded years before when something could have been done. This stopped us in our tracks. We asked ourselves if these had been detected earlier, what difference could it have made?”

Professor Dillion added, “We’ve been predicting that a liver failure epidemic has been coming but now we are seeing hard-evidence that it is already here. We hope that, with continued tests, people drinking too much or eating high-fructose sugars can make the lifestyle changes now that will reduce the number of those coming into hospital with fatal liver failure in the years to come.”

Dr Andrew Fraser, Clinical lead for roll out of iLFT from the Scottish Government’s Modernizing Outpatients Directive, concluded by saying that, “For too long have we seen the rise in patients presenting with advanced liver disease which could have been picked up on routine tests at a much earlier stage. The development by the Dundee team will help to identify those at an early stage where directed intervention can prevent progression to end-stage liver disease. This is only available to patients in Tayside at present and we strongly recommend other health boards adopt it as standard practice across Scotland.”

Source: Journal of Hepatology, University of Dundee