Liver function tests in identifying patients with liver disease

Abstract

Background and aims: Many patients with liver disease come to medical attention once they have advanced cirrhosis or acute decompensation. Most often, patients are screened for liver disease via liver function tests (LFTs). There is very limited published data evaluating laboratory values with biopsy-proven stages of hepatic fibrosis. We set out to evaluate whether any correlation exists between routine LFTs and stages of hepatic fibrosis.

Methods: A large retrospective observational study on 771 liver biopsies was conducted for evaluating the stage of fibrosis with AST, ALT, INR, BUN, creatinine, platelets, alkaline phosphatase, bilirubin, and albumin. Mean and 95% confidence intervals were used to describe the distributions of serum markers in different fibrosis stages. Multivariable generalized linear models were used and a two-tailed P-value was calculated.

Results: ALT was not statistically significant for any stage, and AST was statistically significant for stage 3 and 4 fibrosis. INR was statistically significant only in stage 4 disease but remained near the upper limit of normal range. Albumin failed to show a clinically relevant association. Platelets remained within normal laboratory range for all stages. The remaining laboratory values failed to show statistical and clinical significance.

Conclusion: The health care burden from chronic liver disease (CLD) will likely continue to rise, unless clinicians are made aware that normal or near normal laboratory findings may be seen in asymptomatic patients. Earlier identification of asymptomatic patients will allow for treatment with new promising modalities and decrease morbidity and mortality from CLD. Our study shows that laboratory values correlate poorly with liver disease.

Keywords: HCV; NAFLD; chronic liver disease; cirrhosis; hepatic fibrosis; serum markers.

Figure 1

Six serum markers and fibrosis stage. Notes: Multivariable generalized linear models were used to estimate the predicted values controlling for age, gender, alcohol use, and tobacco use. ^*Statistically significant difference (P<0.05) compared to the fibrosis stage 0. Abbreviation: ALK, alkaline phosphatase.

Figure 2

Four serum markers and fibrosis stage. Notes: Multivariable generalized linear models were used to estimate the predicted values controlling for age, gender, alcohol use, and tobacco use. ^*Statistically significant difference (P<0.05) compared to the fibrosis stage 0. Abbreviation: Cr, creatinine.