Low yield of unselected testing in patients with acutely abnormal liver function tests
Andrew Chadwick1, Michael Marks2
1St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
JRSM Open
|January 16, 2016
Summary
Auditing liver screens for inpatients with abnormal liver function tests revealed a low diagnostic yield. Focusing on patient history, ultrasound, and blood-borne virus testing is crucial for effective diagnosis.
Area of Science:
- Hepatology
- Diagnostic Medicine
- Health Economics
Background:
- Abnormal liver function tests (LFTs) in inpatients necessitate diagnostic evaluation.
- The current practice of 'liver screening' involves a heterogeneous range of investigations.
- The diagnostic yield and cost-effectiveness of these screens require auditing.
Purpose of the Study:
- To audit the diagnostic yield of 'liver screens' in inpatients with abnormal LFTs.
- To evaluate the cost implications associated with these investigations.
- To identify the most effective diagnostic strategies for abnormal LFTs.
Main Methods:
- Retrospective audit of 308 inpatients with abnormal LFTs over 12 months.
- Analysis of all ordered investigations: biochemistry, immunology, virology, and radiology.
- Calculation of diagnostic yield and cost per positive diagnosis for each investigation.
Main Results:
- A final diagnosis was achieved in 73% of patients.
- History and ultrasound were the most productive investigations, yielding 40% and 30% of diagnoses, respectively.
- Autoimmune and metabolic screens demonstrated minimal diagnostic yield.
Conclusions:
- Unselected testing for abnormal LFTs has a low diagnostic yield.
- Key diagnostic tools include thorough patient history, ultrasound, and blood-borne virus testing.
- Specialist consultation is recommended before extensive testing; further prospective studies are warranted.
Keywords:
Clinical diagnostic testsMore Related Videos
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
256
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
256
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
333
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
333
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
1.0K
Endoscopic Ultrasound (EUS) and FibroScan are valuable diagnostic tools in gastroenterology and hepatology, each with specific applications and techniques.
Endoscopic Ultrasound (EUS):
Endoscopic Ultrasound (EUS):
1.0K
01:28Esophageal Varices-II: Clinical Features and Management
752
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
752
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
340
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
340