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Biochemical testing in patients with alcoholic liver disease
F A Hubbell1, D W Webb, M R Ofstein
1Department of Medicine, Veterans Administration Medical Center, Long Beach, Calif.
Southern Medical Journal
|March 1, 1989
Summary
Physicians frequently ordered liver panels for hospitalized alcoholic liver disease patients. However, increased laboratory utilization did not improve clinical outcomes or reduce hospital stay, suggesting less frequent testing is appropriate.
Area of Science:
- Hepatology
- Clinical Chemistry
- Healthcare Management
Background:
- Alcoholic liver disease (ALD) is a significant cause of hospitalization.
- Physician laboratory utilization patterns for ALD patients require evaluation.
- The impact of frequent biochemical testing on ALD patient outcomes is not well-defined.
Purpose of the Study:
- To evaluate laboratory utilization patterns in hospitalized ALD patients.
- To examine the relationship between laboratory test frequency and clinical outcomes.
- To provide evidence-based recommendations for laboratory testing in ALD.
Main Methods:
- Retrospective analysis of 378 hospitalizations for 185 ALD patients.
- Detailed review of liver panel (comprehensive metabolic panel) ordering frequency.
- Correlation analysis between test frequency and length of stay, complications, and survival.
Main Results:
- Liver panels were ordered an average of 7.4 times per hospitalization.
- Increased frequency of biochemical testing did not correlate with decreased length of stay.
- Higher test utilization did not improve clinical outcomes, including complication development or survival.
Conclusions:
- Frequent laboratory testing in ALD patients offers no discernible clinical benefit.
- Current practice of extensive biochemical monitoring is not supported by evidence.
- Recommendations include ordering liver panels only upon admission, discharge, or significant clinical change.