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A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis

Jingwei Gao, Haroon Ahmed Orcid Logo, Rebecca Cannings-John Orcid Logo, Ashley Akbari Orcid Logo, Aled Davies Orcid Logo, Thomas Peter I. Pembroke Orcid Logo

Hepatology Communications, Volume: 10, Issue: 2

Swansea University Authors: Jingwei Gao, Ashley Akbari Orcid Logo

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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...

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Published in: Hepatology Communications
ISSN: 2471-254X
Published: Ovid Technologies (Wolters Kluwer Health) 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71358
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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&#x2013;1.34, p&lt;0.001; second region: incidence rate ratio=1.16, 95% CI: 1.02&#x2013;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&#x2013;1.56, p&lt;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&#x2019;s effect on cirrhosis detection. 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spelling 2026-02-02T14:34:09.7636533 v2 71358 2026-01-30 A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis 34c182010080746a0cc10e1afab6ae62 Jingwei Gao Jingwei Gao true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2026-01-30 MEDS 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. Journal Article Hepatology Communications 10 2 Ovid Technologies (Wolters Kluwer Health) 2471-254X aspartate aminotransferases, clinical pathways, liver cirrhosis, liver diseases, primary health care 1 2 2026 2026-02-01 10.1097/hc9.0000000000000887 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Other This project was partly funded by an unrestricted grant from the Liver Disease Implementation Group, Welsh Government (LDIG-22-19). 2026-02-02T14:34:09.7636533 2026-01-30T16:25:36.9689567 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Jingwei Gao 1 Haroon Ahmed 0000-0002-0634-8548 2 Rebecca Cannings-John 0000-0001-5235-6517 3 Ashley Akbari 0000-0003-0814-0801 4 Aled Davies 0000-0002-7815-5155 5 Thomas Peter I. Pembroke 0000-0002-2600-2034 6 71358__36163__8a6ec454a18d455b89b086b71803fc8d.pdf 71358.VoR.pdf 2026-02-02T14:28:33.6091296 Output 2430398 application/pdf Version of Record true © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License 4.0 (CC BY). true eng http://creativecommons.org/licenses/by/4.0/
title A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
spellingShingle A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
Jingwei Gao
Ashley Akbari
title_short A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
title_full A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
title_fullStr A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
title_full_unstemmed A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
title_sort A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis
author_id_str_mv 34c182010080746a0cc10e1afab6ae62
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv 34c182010080746a0cc10e1afab6ae62_***_Jingwei Gao
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Jingwei Gao
Ashley Akbari
author2 Jingwei Gao
Haroon Ahmed
Rebecca Cannings-John
Ashley Akbari
Aled Davies
Thomas Peter I. Pembroke
format Journal article
container_title Hepatology Communications
container_volume 10
container_issue 2
publishDate 2026
institution Swansea University
issn 2471-254X
doi_str_mv 10.1097/hc9.0000000000000887
publisher Ovid Technologies (Wolters Kluwer Health)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description 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.
published_date 2026-02-01T05:35:08Z
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