Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

Area of Science:

• Primary Care Medicine
• Hepatology
• Clinical Diagnostics

Background:

• Liver function tests (LFTs) are commonly performed in primary care.
• Abnormal LFT results in patients without known liver disease require careful evaluation.
• Current guidelines for LFT interpretation may not be optimal.

Purpose of the Study:

• To evaluate mildly abnormal liver function test (LFT) results in general practice.
• To identify the diagnostic utility of different LFT analytes.
• To assess the clinical significance and patient outcomes of abnormal LFTs.

Main Methods:

• Prospective cohort study in eleven UK primary care practices.
• Inclusion of adults with abnormal LFTs but no known liver disease.
• Intensive investigation and 2-year follow-up using a common protocol.

Main Results:

• Fewer than 5% of patients with abnormal LFTs had a specific liver disease, often treatable.
• Alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were the most diagnostically valuable LFTs.
• Forty percent of patients had 'fatty liver' on ultrasound; weight loss reduced liver fat.
• Abnormal LFTs caused temporary anxiety but no sustained behavioral change.

Conclusions:

• Liver disease is uncommon in primary care patients with abnormal LFTs.
• A simplified LFT panel focusing on ALT and ALP may be sufficient.
• Repeating abnormal LFTs is often inefficient; targeted specific testing is preferred.
• Obesity and elevated ALT are strong indicators of 'fatty liver'.