O21 Intelligent liver function testing: 18 months of real world data

Abstract

Introduction Liver Function Tests (LFTs) are abnormal in 20% of cases in primary care. In addition, mortality from chronic liver disease continues to rise. Intelligent liver function testing (iLFT) was designed to improve diagnosis of liver disease, the quality of further investigations, and optimise the time of referral to secondary care. This will reduce both mortality and cost to practitioners. Following a trial it was launched in Tayside, Scotland in August 2018. Referrers provide information on alcohol intake, BMI and comorbidities, and those with abnormal LFTs have reflex tests including non-invasive fibrosis scores, without further venepuncture. General Practitioners (GPs) are provided with management plans with a recommended outcome: secondary care referral for fibrosis assessment or treatment; primary care follow up of early liver disease; or when a diagnosis is unclear, staging information including referral criteria. Methods A retrospective analysis was performed of all patients who had iLFT requested by GPs in the first eighteen months (August 2018 – January 2020) of the live system, recording the outcome(s) for each request. Results 4194 requests were received for iLFT in the first eighteen months from launch. iLFT did not cascade in 1106 cases, either because all liver enzymes were normal, or because insufficient data was provided. There were 4012 iLFT outcomes. The most common outcome was isolated ALT elevation without fibrosis (n=884; 22%), followed by alcohol related liver disease without fibrosis (n=534, 13.3%) and non-alcoholic fatty liver disease with fibrosis (n=354; 8.8%). The frequency of each outcome is shown in figure 1. Secondary care referral was recommended in 951 (23.7%) cases; of which 732 (77%) were for fibrosis assessment only. The remaining 3061 (76.3%) outcomes recommended primary care management. The number of iLFT requests rose each month from launch, from 159 in November 2018 to 431 in December 2019, and these now make up over 3% of all LFT requests in Tayside. Conclusions iLFT safely and rapidly detects patients at risk of chronic liver disease using reflex fibrosis scores and autoimmune, virology and genetic tests. Secondary care referral is recommended in only 24% of cases, and thus 76% of patients can be managed in primary care. The number of iLFT requests is rising each month. GPs initially used iLFT to investigate patients known to have abnormal LFTs, resulting in high numbers of full test cascades. iLFT is now being used as the first test, so the number cascading is falling, but still improving the diagnosis of liver disease. This ensures patients who require secondary care are seen, whilst reducing unnecessary referrals.