Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton.
Br J Gen Pract. 2012 Sep;62(602):e616-24. doi: 10.3399/bjgp12X654588.
Liver disease develops silently and presents late, with often fatal complications.
To develop a 'traffic light' test for liver disease suitable for community use that could enhance assessment of liver risk and allow rational referral of more severe disease to specialist care.
Two cohorts from Southampton University Hospital Trust Liver Unit: model development and a validation cohort to evaluate prognosis.
A total of 1038 consecutive liver patients (inpatient and outpatient) (development n = 397, validation n = 641) for whom the relevant blood tests had been performed, were followed for a mean of 46 months (range 13-89 months). Blood tests for: hyaluronic acid (HA), procollagen-3 N-terminal peptide (P3NP), and platelet count were combined in a diagnostic algorithm to stage liver disease.
A simple clinical rule combined: HA, P3NP, and platelet count into a 'traffic light' algorithm, grading the results red--high risk, amber--intermediate risk, and green--low risk. In the validation cohort, no green subjects died or developed varices or ascites (n = 202); in the amber group, 9/267 (3.3%) died, 0/267 developed varices, and 2/267 (0.7%) developed ascites; in the red group, 24/172 died (14%), 24/172 (14%) developed varices, and 20/172 developed (11.6%) ascites. Survival was reduced in red (P<0.001) and amber (P<0.012) groups compared with green.
A simple blood test triages liver disease into three prognostic groups; used in the community, it could enhance the management of risk factors in primary care and rationalise secondary care referrals, including the many patients with fatty liver and relatively minor elevations in alanine transaminase.
肝脏疾病悄然发展，晚期出现，常伴有致命并发症。
开发一种适用于社区使用的“红绿灯”肝脏疾病检测，以增强对肝脏风险的评估，并合理将更严重的疾病转介至专科治疗。
南安普顿大学医院信托肝脏科的两个队列：模型开发和验证队列，用于评估预后。
共纳入 1038 例连续的肝脏疾病患者（住院和门诊）（开发队列 n = 397，验证队列 n = 641），这些患者的相关血液检测已完成，平均随访 46 个月（范围 13-89 个月）。血液检测包括透明质酸（HA）、III 型前胶原氨基端肽（P3NP）和血小板计数，这些检测被组合在一个诊断算法中以分期肝脏疾病。
一个简单的临床规则将 HA、P3NP 和血小板计数组合成一个“红绿灯”算法，将结果分为红色（高风险）、琥珀色（中风险）和绿色（低风险）。在验证队列中，没有绿色组的患者死亡或出现静脉曲张或腹水（n = 202）；在琥珀色组中，267 例患者中有 9 例（3.3%）死亡，267 例患者中无 0 例出现静脉曲张，267 例患者中 2 例（0.7%）出现腹水；在红色组中，172 例患者中有 24 例死亡（14%），172 例患者中有 24 例出现静脉曲张，20 例（11.6%）出现腹水。与绿色组相比，红色组（P<0.001）和琥珀色组（P<0.012）的患者生存率降低。
一种简单的血液检测可将肝脏疾病分为三个预后组；在社区中使用，可以增强初级保健中危险因素的管理，并合理转介二级保健，包括许多患有脂肪肝和丙氨酸转氨酶轻度升高的患者。
