Division of Clinical and Molecular Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Division of Clinical and Molecular Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
J Hepatol. 2019 Oct;71(4):699-706. doi: 10.1016/j.jhep.2019.05.033. Epub 2019 Jun 19.
BACKGROUND & AIMS: Liver function tests (LFTs) are frequently requested blood tests which may indicate liver disease. LFTs are commonly abnormal, the causes of which can be complex and are frequently under investigated. This can lead to missed opportunities to diagnose and treat liver disease at an early stage. We developed an automated investigation algorithm, intelligent liver function testing (iLFT), with the aim of increasing the early diagnosis of liver disease in a cost-effective manner.
We developed an automated system that further investigated abnormal LFTs on initial testing samples to generate a probable diagnosis and management plan. We integrated this automated investigation algorithm into the laboratory management system, based on minimal diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. This algorithm then generated a diagnosis and/or management plan. A stepped-wedged trial design was utilised to compare LFT outcomes in general practices in the 6 months before and after introduction of the iLFT system. Diagnostic outcomes were collated and compared.
Of eligible patients with abnormal LFTs, 490 were recruited to the control group and 64 were recruited to the intervention group. The primary diagnostic outcome was based on the general practitioner diagnosis, which agreed with the iLFT diagnosis in 67% of cases. In the iLFT group, the diagnosis of liver disease was increased by 43%. Additionally, there were significant increases in the rates of GP visits after diagnosis and the number of referrals to secondary care in the iLFT group. iLFT was cost-effective with a low initial incremental cost-effectiveness ratio of £284 per correct diagnosis, and a saving to the NHS of £3,216 per patient lifetime.
iLFT increases liver disease diagnoses, improves quality of care, and is highly cost-effective. This can be achieved with minor changes to working practices and exploitation of functionality existing within modern laboratory diagnostics systems.
There is a growing epidemic of advanced liver disease, this could be offset by early detection and management. Checking liver blood tests (LFTs) should be an opportunity to diagnose liver problems, but abnormal results are often incompletely investigated. In this study we were able to substantially increase the diagnostic yield of the abnormal LFTs using the automated intelligent LFT system. With the addition of referral recommendations and management plans, this strategy provides optimum investigation and management of LFTs and is cost saving to the NHS.
肝功能检查（LFT）是一种常用的血液检查，它可能提示肝脏疾病。LFT 结果异常很常见，但这些异常的原因可能很复杂，且常常未得到充分调查。这可能导致错失在早期诊断和治疗肝脏疾病的机会。我们开发了一种自动化调查算法，即智能肝功能检测（iLFT），旨在以具有成本效益的方式更有效地早期诊断肝脏疾病。
我们开发了一种自动化系统，该系统可进一步调查初始检测样本中的异常 LFT，以生成可能的诊断和管理计划。我们根据最低诊断标准、肝纤维化评估以及肝脏疾病病因的反射检测，将此自动化调查算法集成到实验室管理系统中。然后，该算法会生成诊断和/或管理计划。我们采用逐步楔形试验设计，比较 iLFT 系统引入前后 6 个月内普通诊所的 LFT 结果。我们整理并比较了诊断结果。
在异常 LFT 的合格患者中，有 490 名患者被纳入对照组，64 名患者被纳入干预组。主要诊断结果基于全科医生的诊断，其中 67%的病例与 iLFT 诊断相符。在 iLFT 组中，肝脏疾病的诊断增加了 43%。此外，iLFT 组的 GP 就诊率和向二级护理转诊的人数均显著增加。iLFT 的成本效益高，每正确诊断的增量成本效益比为 284 英镑，每位患者终生可节省 NHS 3216 英镑。
iLFT 可增加肝脏疾病的诊断，改善护理质量，并且具有很高的成本效益。通过对现行实验室诊断系统的功能进行少量更改，即可实现这种效果。
晚期肝脏疾病的发病率不断上升，早期发现和管理可能会降低这一发病率。检查肝功能检查（LFT）应该是诊断肝脏问题的机会，但异常结果常常未得到充分调查。在这项研究中，我们使用自动化智能 LFT 系统大大提高了异常 LFT 的诊断效果。通过添加转诊建议和管理计划，这种策略可优化 LFT 的检查和管理，为 NHS 节省成本。
