Al Harthi Thuraiya, Whiting Penny, Watson Jessica
Research Department, The Royal Hospital, Ministry of Health, Muscat, Oman.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
BJGP Open. 2024 Apr 25;8(1). doi: 10.3399/BJGPO.2023.0082. Print 2024 Apr.
Liver function tests (LFTs) are frequently used to monitor patients with hypertension in UK primary care. Evidence is lacking on whether testing improves outcomes.
To estimate the diagnostic accuracy of LFTs in patients with hypertension and determine downstream consequences of testing.
DESIGN & SETTING: Prospective study using the Clinical Practice Research Datalink (CPRD).
In total, 30 000 patients with hypertension who had LFTs in 2015 were randomly selected from CPRD. The diagnostic accuracy measures for eight LFT analytes and an overall LFT panel were calculated against the reference standard of liver disease. Rates of consultations, blood tests, and referrals within 6 months following testing were measured.
The 1-year incidence of liver disease in patients with hypertension was 0.5% (95% confidence interval [CI] = 0.4% to 0.6%). Sensitivity and specificity of an LFT panel were modest: 61.3% (95% CI = 53.1% to 69.0%) and 73.8% (95% CI = 73.1% to 74.3%), respectively. The positive predictive value (PPV) of the eight individual LFT analytes were low ranging from 0.2% to 8.9%. Among patients who did not develop liver disease, mean number of consultations, referrals, and tests were higher in the 6 months following false-positives at 10.5, 0.7 and 29.8, respectively, compared with true-negatives: 8.6, 0.6, and 19.8.
PPVs of LFTs in primary care were low, with high rates of false-positive results and increased rates of subsequent consultations, referrals, and blood testing. Avoiding LFTs for routine monitoring could potentially reduce patients' anxiety, GP workload, and healthcare costs.
在英国初级医疗保健中，肝功能检查（LFTs）经常用于监测高血压患者。目前缺乏关于该项检查是否能改善预后的证据。
评估LFTs对高血压患者的诊断准确性，并确定检查的下游后果。
使用临床实践研究数据链（CPRD）进行的前瞻性研究。
从CPRD中随机选取2015年进行过LFTs检查的30000例高血压患者。根据肝病参考标准计算8种LFT分析物和整体LFT指标的诊断准确性指标。测量检查后6个月内的会诊率、血液检查率和转诊率。
高血压患者的肝病1年发病率为0.5%（95%置信区间[CI]=0.4%至0.6%）。LFT指标的敏感性和特异性一般：分别为61.3%（95%CI=53.1%至69.0%）和73.8%（95%CI=73.1%至74.3%）。8种LFT分析物的阳性预测值（PPV）较低，范围为0.2%至8.9%。在未患肝病的患者中，假阳性结果后的6个月内，平均会诊次数、转诊次数和检查次数分别为10.5、0.7和29.8，高于真阴性患者：8.6、0.6和19.8。
初级医疗保健中LFTs的PPV较低，假阳性结果率较高，随后的会诊、转诊和血液检查率也有所增加。避免进行LFTs常规监测可能会降低患者的焦虑、全科医生工作量和医疗成本。
