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Liver blood marker testing in UK primary care: a UK wide cohort study, 2004-2016

Polly Scutt1, Lu Ban1,2, Tim Card1,3

  • 1Lifespan and Population Health, University of Nottingham, Nottingham, UK.

BMJ Open
|September 27, 2022
PubMed

Insights

Liver enzyme testing frequency in UK general practice increased for most markers but decreased for AST and GGT. Patients with chronic liver disease risk factors received more liver marker assessments.

Area of Science:

  • Hepatology and Gastroenterology
  • Public Health and Epidemiology
  • Primary Care Medicine

Background:

  • Liver enzyme testing is crucial for diagnosing and monitoring chronic liver disease (CLD).
  • Understanding temporal trends in liver enzyme testing is essential for evaluating current clinical practice and guidelines.
  • Variations in testing among at-risk subgroups require investigation to ensure equitable and effective patient care.

Purpose of the Study:

  • To analyze temporal trends in liver enzyme testing (ALT, AST, GGT, ALP, bilirubin, platelets) in UK general practice between 2004 and 2016.
  • To examine how these testing frequencies differ across patient subgroups identified as being at high risk for CLD.
  • To assess the implications of observed trends for clinical guidance and patient management.

Main Methods:

  • Retrospective cohort study utilizing the UK Clinical Practice Research Datalink (CPRD) database.
  • Inclusion of adult patients (18+ years) registered in CPRD from January 2004 to December 2016.
  • Calculation of testing frequencies for specific liver enzymes and platelet counts, with subgroup analyses for CLD risk factors.

Main Results:

  • A cohort of 2,912,066 individuals with a median follow-up of 3.2 years was analyzed.
  • Testing for ALT, ALP, bilirubin, and platelets generally increased, while AST and GGT testing declined over the study period.
  • By 2016, annual testing proportions were: platelets 28.0%, ALP 26.2%, bilirubin 25.6%, ALT 23.7%, GGT 5.1%, and AST 2.2%.
  • Patients with CLD risk factors showed higher rates of liver marker assessment compared to those without.

Conclusions:

  • A significant decline in aspartate aminotransferase (AST) testing has occurred, potentially impacting routine clinical guidance.
  • Current liver enzyme testing patterns may not optimally target individuals at risk for CLD.
  • A more targeted approach, focusing non-invasive markers on high-risk populations, is suggested for improved CLD management.
Abstract

Keywords:
aspartate aminotransferaseearly diagnosispolicypopulationscreening

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