GPs could find directly ordering specific tests more efficient than doing repeated LFTs as currently recommended, suggests an NHS-funded review that shows patients with abnormal results rarely turn out to have serious liver disease.
They found less than 5% of people with abnormal LFT results had a specific disease of the liver, many of which were unlikely to need treatment.
In the large majority of patients – 84% – abnormal LFT results were still abnormal on retesting a month later, meaning current guidelines on repeated testing were ‘inefficient’ concluded the researchers
The health technology assessment - which Pulse has learnt will be published this week - studied the use of LFTs at eleven primary care practices, eight in Birmingham and three in Lambeth, in which patients with mildly abnormal LFT results were followed up for two years.
Led by Professor Richard Lilford, from the University of Birmingham, the authors concluded: ‘LFT results seldom revert from abnormal to normal over a one-month period, and modelling shows that repeating an abnormal LFT panel, as recommended in the current guidelines, is inefficient.’
The team also found most of the diagnostic value of LFTs came down to two analytes – alanine aminotransferase (ALT) and alkaline phosphatase (ALP).
The authors concluded: ‘Liver disease is rare among people with abnormal LFT results in primary care. Only two analytes (ALT and ALP) are helpful in identifying the majority of liver disease.’
It adds: ‘LFT results seldom revert from abnormal to normal over a 1-month period, and modelling shows that repeating an abnormal LFT panel, as recommended in the current guidelines, is inefficient.’
The researchers concluded the ‘acceptability of replacing the traditional six- to eight-analyte LFT panel with a drop-down menu including the ALT/ALP combination should be evaluated’.
Dr John O’Malley, chair of the primary care reference group for the National Liver Strategy and a GP in Manchester, commented: ‘My concern is why were the tests done in the first place. Indiscriminate testing will create lots of “abnormal” results that will not indicate any liver disease.
‘However, targeted testing is a far more considered approach and I would not take this paper to mean that testing for abnormal liver “function” is a waste of time and discourage the use of full liver screens when indicated. We need more information before primary care takes this and changes practice.’
Dr Michael Cohen, member of the Primary Care Society for Gastroenterology steering committee and a GP in Bristol, said the findings suggest some tests are being done unnecessarily.
He said: ‘More and more LFTs are being done in primary care. If the diagnostic yield for liver disease is low in those with mildly abnormal tests, we could be subjecting a lot of patients to more unnecessary tests and using up scant resources.’
Health Technol Assess 2013; 17 (28): 1–307
