Sensitivity and Specificity of Tests of Liver Injury

Abstract

Editor - In the recent “Outpatient Practice Management Tips: Tests of Liver Injury”, Musana et al.1 make a broad statement that “All tests of liver injury are neither highly sensitive nor specific.” This statement, by itself, is probably not accurate, nor helpful in the practical sense. The following quotes from Harrison's Principles of Internal Medicine textbook illustrate the problems with your statement regarding liver disease and tests of liver function: “Diagnosis of liver disease is greatly aided by the availability of reliable and sensitive tests of liver injury and function.”2 “To increase both the sensitivity and the specificity of laboratory tests in the detection of liver disease, it is best to use them as a battery.”3 Thus, I would rather the statement read “No single test of liver injury is neither highly sensitive nor specific.” Harrison's Principles of Internal Medicine is clear in the basic wisdom of diagnosing liver injury that these tests are highly sensitive when used in a battery and goes on to add: “When more than one of these tests provide abnormal findings, or the findings are persistently abnormal on serial determinations, the probability of liver disease is high. When all test results are normal, the probability of missing occult liver disease is low.”3