Routine blood tests may prevent serious liver events in advance liver disease
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Using routine blood tests may identify patients at risk for advanced liver disease, according to results published in BMJ Open.
“This information needed to calculate the [Cirrhosis Using Standard tests (CIRRUS)] is probably already available to most U.K. primary care doctors for a majority of patients in the community who are likely to suffer their first [ serious liver event (SLE)] over the next 5 years,” Theresa Hydes, MD, from the School of Primary Care and Population Sciences, University of Southampton, and colleagues wrote. “This first event is often fatal; if our study is validated in different cohorts, it is possible many of these patients could be warned of an impending disaster that could potentially be averted.”
At the University of Southampton, Hydes and colleagues performed logistic regression on routinely collected blood test data from 16,967 patients who underwent upper gastrointestinal endoscopy from 2005 to 2016.
Investigators then used data to develop the CIRRUS model to detect advanced liver disease. They included two cohorts of 394,253 patients from United Health Services (UHS) primary and secondary care and 183,045 patients from Care and Health Information Exchange (CHIE) primary care to validate the prediction of a first SLE.
Cirrhosis or portal hypertension and SLE served as the primary outcome measures.
Investigators noted 931 SLEs were recorded. An area under the curve of 0.9 (95% CI, 0.88-0.92) for cirrhosis and hypertension was detected with CIRRUS.
Results showed 3,044 SLEs recorded in the UHS validation cohort and 1,170 in the CCHIE cohort.
“In the UHS cohort, CIRRUS predicted a first SLE within 5 years with an AUC of 0.9 (0.89 to 0.91) continuous, 0.88 (0.87 to 0.89) categorized (crimson, red, amber, green grades); and AUC 0.84 (0.82 to 0.86) and 0.83 (0.81 to 0.85) for the CHIE cohort,” the researchers wrote. “In patients with a specified liver risk factor (alcohol, diabetes, viral hepatitis), a crimson/red cut-off predicted a first SLE with a sensitivity of 72%/59%, specificity 87%/93%, positive predictive value 26%/18% and negative predictive value 98%/99% for the UHS/CHIE validation cohorts, respectively.”