scholarly journals Reducing liver function tests for statin monitoring: an observational comparison of two clinical commissioning groups

2017 ◽  
Vol 67 (656) ◽  
pp. e194-e200 ◽  
Author(s):  
Kate Homer ◽  
John Robson ◽  
Susannah Solaiman ◽  
Abigail Davis ◽  
Saima Zubeda Khan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Liver Function Tests ◽  
Post Intervention ◽  
Cross Sectional ◽  
Function Tests ◽  
Liver Function Testing ◽  
Periodic Testing ◽  
Function Test ◽  
Function Testing

BackgroundCurrent liver function testing for statin monitoring is largely unnecessary and costly. Statins do not cause liver disease. Both reduction in test frequency and use of a single alanine transaminase (ALT) rather than a full seven analyte liver function test (LFT) array would reduce cost and may benefit patients.AimTo assess LFT testing in relation to statin use and evaluate an intervention to reduce full-array LFTs ordered by GPs for statin monitoring.Design and settingTwo-year cross-sectional time series in two east London clinical commissioning groups (CCGs) with 650 000 patients. One CCG received the intervention; the other did not.MethodThe intervention comprised local guidance on LFTs for statin monitoring and access to a single ALT rather than full LFT array.ResultsOf the total population, 17.6% were on statins, accounting for 43.2% of total LFTs. In the population without liver disease, liver function tests were 3.6 times higher for those on statins compared with those who were not. Following intervention there was a significant reduction in the full LFT array per 1000 people on statins, from 70.3 (95% confidence interval [CI] = 66.3 to 74.6) in the pre-intervention year, to 58.1 (95% CI = 55.5 to 60.7) in the post-intervention year (P<0.001). In the final month, March 2016, the rate was 53.2, a 24.3% reduction on the pre-intervention rate.ConclusionThis simple and generalisable intervention, enabling ordering of a single ALT combined with information recommending prudent rather than periodic testing, reduced full LFT testing by 24.3% in people on statins. This is likely to have patient benefit at reduced cost.

scholarly journals Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032890 ◽  
Author(s):  
Geraldine O'Hara ◽  
Jolynne Mokaya ◽  
Jeffrey P Hau ◽  
Louise O Downs ◽  
Anna L McNaughton ◽  
...  
Keyword(s):  
Liver Disease ◽  
Alcohol Consumption ◽  
Liver Function ◽  
Reference Range ◽  
Liver Function Tests ◽  
Sub Saharan Africa ◽  
Reference Ranges ◽  
Cross Sectional ◽  
Function Tests ◽  
Glutamyl Transferase

ObjectivesLiver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.DesignWe undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).SettingWe studied a population cohort in South-Western Uganda.ParticipantsData were available for 8099 adults (median age 30 years; 56% female).ResultsThe prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.ConclusionsFurther work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.

How to interpret and manage abnormal liver blood test results in older people

2021 ◽  
pp. 1-8
Author(s):  
Mohsan Subhani ◽  
Abhishek Sheth ◽  
Bilal Ahmad ◽  
Stephen Ryder
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Test Results ◽  
Older Population ◽  
The Metabolic Syndrome ◽  
Function Tests ◽  
Function Test ◽  
Common Observation

Ageing impairs liver function and reduces the liver's regenerative capacity. With the predicted increase in the older population, the burden of liver disease will proportionally rise in this age group. Elevated levels of liver enzymes in an otherwise asymptomatic older individual (≥65 years) are a common observation and positively associated with the metabolic syndrome, whereas a decline in albumin levels is linked with a rise in all-cause and liver-specific mortality. Deranged liver function tests do not always indicate liver disease, nor do normal liver function tests exclude liver disease. Therefore, clinicians need to consider individual patient risk factors during the assessment of abnormal liver function tests. This article discusses various liver function tests, their pathophysiology, and the approach to interpret and manage common abnormalities in liver function test results and liver disease in the older population.

scholarly journals Intelligent Liver Function Testing: Working Smarter to Improve Patient Outcomes in Liver Disease

2020 ◽  
Vol 5 (5) ◽  
pp. 1090-1100
Author(s):  
Iain Macpherson ◽  
Jennifer H Nobes ◽  
Eleanor Dow ◽  
Elizabeth Furrie ◽  
Michael H Miller ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Pilot Trial ◽  
Premature Mortality ◽  
Liver Function Tests ◽  
Automated System ◽  
National Guidelines ◽  
Blood Tests ◽  
Liver Function Testing ◽  
Function Testing

Abstract Chronic liver disease (CLD) is a significant health problem affecting millions of people worldwide. In Scotland, CLD is a major cause of premature mortality. Liver function tests (LFTs) are a panel of frequently requested blood tests which may indicate liver disease. However, LFTs commonly contain at least one abnormal result, and abnormalities are rarely investigated to the extent recommended by national guidelines. The intelligent Liver Function Testing (iLFT) pathway is a novel, automated system designed to improve early diagnosis of liver disease. Initial abnormal LFT results trigger a cascade of reflexive testing to help identify the cause of any liver dysfunction. Algorithms combine these results with demographic and clinical data (such as patient age, body mass index, and alcohol intake) and fibrosis estimates to produce an electronic diagnosis and management plan. The pilot trial demonstrated that iLFT increased diagnosis of liver disease whilst remaining cost-effective. As such, iLFT has been fully operational across our region (NHS Tayside, Scotland) since August 2018. In the first year, iLFT generated over 2000 diagnoses from 1824 patient samples with an abnormality in the initial LFTs. The majority of these patients could be safely managed in primary care. iLFT allows maximal value to be obtained from liver blood tests across biochemistry, virology, immunology, and hematology with only minor changes to working practices. ‘Intelligent’, algorithm-led testing pathways break down the barrier between clinical and laboratory medicine and offer solutions to many of the challenges experienced in modern healthcare systems.

scholarly journals Author Reply—Bariatric Surgery and Liver Function Tests in Nonalcoholic Fatty Liver Disease

2017 ◽  
Vol 27 (4) ◽  
pp. 1060-1060
Author(s):  
Geraldine J. Ooi ◽  
Paul R. Burton ◽  
William W. Kemp ◽  
Stuart K. Roberts ◽  
Wendy A. Brown
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Liver Function ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Liver Function Tests ◽  
Author Reply ◽  
Nonalcoholic Fatty Liver ◽  
Function Tests

scholarly journals Vegan Diet Advice Might Benefit Liver Enzymes in Nonalcoholic Fatty Liver Disease: an Open Observational Pilot Study

2021 ◽  
Author(s):  
Giuseppe Chiarioni ◽  
Stefan Lucian Popa ◽  
Andrea Dalbeni ◽  
Carlo Senore ◽  
Daniel Corneliu Leucuta ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Liver Disease ◽  
Liver Function ◽  
Fatty Liver Disease ◽  
Liver Enzymes ◽  
Liver Function Tests ◽  
Vegan Diet ◽  
Nonalcoholic Fatty Liver ◽  
Function Tests

Background and Aims: The Western diet is rich in saturated fats, refined sugars and meat consistent with a high-energy load and secondary risk of increased metabolic diseases including nonalcoholic fatty liver disease (NAFLD). However, no data are available on potential benefit of vegan diets in NAFLD and/or nonalcoholic steatohepatitis (NASH). We aimed to study prospectively the effect of a vegan diet, excluding all animal products on liver chemistry in a group of consecutive NAFLD patients. Methods: This was a prospective, pilot study run on 40 consecutive patients affected by NAFLD. Eight subjects refused to join the study for poor diet palatability, leaving 32 patients (19 males, mean age 50 years), with abnormal measures of liver function who agreed to adhere to a vegan diet for six months. The caloric intake was tailored by the dietitian to obtain a weight loss ≥5% of body weight in overweight patients [body-mass index (BMI) ≥25] and ranged from 1500 Kcal to 1800 Kcal. Patients were contacted monthly by phone to reinforce diet and lifestyle advice and were seen at the gastrointestinal clinic when doubtful about diet advice. Results: At six-month follow-up, 6 subjects did not attend the clinic leaving only 26 patients for data analysis. Initial anthropometric values were mean weight 78 kg (range 52-95), mean body mass index (BMI) 26.8 Kg/m2 (range 20.3-31.2). Liver function tests showed mean ALT value 99 U/L (SD±45), mean AST value 54 U/L (SD±44), mean GGT value 160 U/L (SD±122), pre-treatment. After six months mean body weight was 73 Kg (range 52-87), mean BMI was 25.2 Kg/m2 (range 20.3-29.7) (p<0.001 compared to baseline for both parameters). Liver enzymes improved to a mean of ALT value 36 U/L (SD±21), AST value 27 U/L (SD±10) and GGT value 55 U/L (SD±57), respectively (p<0.001 compared to baseline for all enzymes). Normalization of liver function tests as a whole was observed in 20/26 patients (76.9%). A loss of ≥ 5% of body weight was observed in 12 patients (46.1%), but it did not correlate with the normalization of liver function tests (p=0.5). Conclusions: Our data provide preliminary evidence of improved liver enzymes in NAFLD patients with a strict vegan diet and although our study sample is limited, decreased body weight did not seem critical to the outcome.

scholarly journals Assessment of Liver Function Tests in Children with Typhoid Fever: A Hospital Based Study

2019 ◽  
Vol 17 (2) ◽  
pp. 21-22
Author(s):  
Shakil Ahmad
Keyword(s):  
Liver Function ◽  
Typhoid Fever ◽  
Liver Function Test ◽  
Liver Function Tests ◽  
Serum Glutamic Oxaloacetic Transaminase ◽  
Medical College ◽  
Endemic Diseases ◽  
Function Tests ◽  
Function Test ◽  
Loss Of Appetite

Background: Typhoid fever is among the most endemic diseases in the tropics and which causes significant morbidity and mortality. It can lead to liver damage if not properly treated. Therefore, the liver function test assessment was conducted in children with typhoid fever. Our study aimed to evaluate the liver function test abnormalities in typhoid fever. Material and methods: This was a prospective observational study conducted at the department of paediatrics, Nepalgunj Medical College and Teaching hospital, Nepalgunj for a period of one year August 2018-July 2019.In the present study total 60 children of Typhoid fever were included on the basis of inclusion and exclusion criteria. On admission a detailed history and complete physical examination was carried out. Routine investigations were also carried out. The diagnosis was confirmed by serum Widal test. Liver function tests were performed i.e. Serum glutamic oxaloacetic transaminase [SGOT] and serum glutamic pyruvic transaminase [SGPT] estimation. Result: In the present study total children were 60 in which 43.33% were boys and 56.66% were girls. Fever was present in all the cases loss of appetite, cough, vomiting was present in majority of cases. On admission, SGOT and SGPT levels were found > 35 IU/L in 26 cases (43.33%) and 34 cases (56.66%) respectively. On discharge after 7 days of antibiotic, majority of patients had SGOT and SGPT levels < 35 IU/L. Conclusion: Our study concluded that on admission of children SGOT and SGPT levels were found > 35 IU/L in 43.33% and 56.66% respectively. On discharge after 7 days of antibiotic, majority of patients had SGOT and SGPT levels < 35 IU/L.

scholarly journals Cystic fibrosis-related liver disease: a single-center experience

2011 ◽  
Vol 3 (3) ◽  
pp. 21 ◽  
Author(s):  
Paula Catarino Costa ◽  
Celeste Canha Barreto ◽  
Luisa Pereira ◽  
Maria Luisa Lobo ◽  
Maria Adília Costa ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Liver Disease ◽  
Liver Function ◽  
Pediatric Patients ◽  
Liver Function Tests ◽  
Liver Involvement ◽  
Clinical Expression ◽  
Function Tests ◽  
Related Liver Disease

Prospective studies concerning liver disease in pediatric cystic fibrosis patients are scarce. The present study aimed to describe the prevalence and clinical expression of cystic fibrosis - related liver disease, in a cohort of 62 pediatric patients. Descriptive study, resulting from the prospective evaluation, between 1994 and 2009, of 62 pediatric patients (age &lt;18 years) with cystic fibrosis. The follow-up protocol included a clinical assessment every 2 months, liver function tests every 6 months and annual liver ultrasonography. The cumulative prevalence of liver disease was 11.2% (7/62 cases). All patients had ΔF508 mutation and pancreatic insufficiency, none had meconium ileus. The liver involvement became clinically evident at a mean age of 8 years (3-15 years), revealed by hepatomegaly or hepatosplenomegaly (3 cases) and/ or abnormalities of liver function tests (3 cases) changes of liver ultrasound (7 cases) with evidence of portal hypertension (2 cases). Four patients were submitted to liver biopsy; biliary fibrosis was documented in one case, focal biliary cirrhosis in 2 cases and multilobular cirrhosis in another case. Within a median 11.6 years follow-up period (all patients under UDCA therapy after liver disease diagnosis), progression of liver disease was observed in 2 patients; one patient developed refractory variceal bleeding and progressive hepatic failure, requiring liver transplant. The results of the present study agree with those of previous pediatric studies, further documenting clinical expression of liver disease in CF patients, which is usually detected in the first decade of life and emphasize the contribution of ultrasound to early diagnosis of liver involvement. Moreover, although advanced liver disease is a relatively rare event, early isolated liver transplantation may have to be considered at this age group.

Echo-doppler hepatic measurements combined with quantitative liver function tests in chronic liver disease

2000 ◽  
Vol 32 ◽  
pp. 223
Author(s):  
A. Fasoli ◽  
P. Borro ◽  
F. Botta ◽  
B. Chiarbonello ◽  
P. Durando ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Chronic Liver Disease ◽  
Liver Function Tests ◽  
Chronic Liver ◽  
Function Tests
Sign in / Sign up

Export Citation Format

Share Document