Journal article 48 views 8 downloads
A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
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Rebecca Cannings-John ,
Ashley Akbari ,
Aled Davies ,
Thomas Peter I. Pembroke
Hepatology Communications, Volume: 10, Issue: 2
Swansea University Authors:
Jingwei Gao, Ashley Akbari
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DOI (Published version): 10.1097/hc9.0000000000000887
Abstract
Background: To enhance early liver disease detection, a clinical pathway integrating reflex AST testing and automated AAR reporting was implemented. We aim to evaluate the long-term effectiveness of introducing reflex AST testing by assessing its impact after implementation in 2 regions of Wales.Met...
| Published in: | Hepatology Communications |
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| ISSN: | 2471-254X |
| Published: |
Ovid Technologies (Wolters Kluwer Health)
2026
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa71358 |
| Abstract: |
Background: To enhance early liver disease detection, a clinical pathway integrating reflex AST testing and automated AAR reporting was implemented. We aim to evaluate the long-term effectiveness of introducing reflex AST testing by assessing its impact after implementation in 2 regions of Wales.Methods: We applied a quasi-experimental, Difference-in-Difference approach to evaluate the introduction of the reflex AST:ALT pathway in Wales (January 2010 to December 2023). Outcomes were the monthly incidence rate of (1) chronic liver disease (including cirrhosis) and (2) cirrhosis in the 2 intervention regions versus the control regions.Results: In total, 78,917 individuals with liver disease were included in the study. A significant increase in cirrhosis diagnoses was observed in both regions (first region: incidence rate ratio=1.24, 95% CI: 1.15–1.34, p<0.001; second region: incidence rate ratio=1.16, 95% CI: 1.02–1.33, p=0.028). The incidence of composite chronic liver disease (including cirrhosis) increased transiently in the second region only (incidence rate ratio=1.35, 95% CI: 1.16–1.56, p<0.001).Conclusions: In this long-term, population-level evaluation, reflex AST:ALT testing increased cirrhosis detection in both regions and produced a short-term rise in chronic liver disease (including cirrhosis) diagnoses one region, strengthening the evidence of the pathway’s effect on cirrhosis detection. Further study is warranted to understand regional variation. |
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| Keywords: |
aspartate aminotransferases, clinical pathways, liver cirrhosis, liver diseases, primary health care |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
This project was partly funded by an unrestricted grant from the Liver Disease Implementation Group, Welsh Government (LDIG-22-19). |
| Issue: |
2 |