Researchers at the University of Dundee and NHS Tayside say they have developed a new method of detecting liver disease decades before it can become fatal.
Liver disease, which is often asymptomatic, has become the second most common cause of death in under 65-year-olds in the U.K. Unlike other common causes of death which have begun to decline in recent years, the age-standardized mortality rates for liver disease have risen by nearly 600% since the 1970s.
Liver function is routinely investigated by testing blood samples requested by general practitioners. Results commonly show abnormal liver function but this is often under-investigated due to the many different and complex reasons for an abnormal result. This misses the opportunity to diagnose and treat liver disease at an early stage.
“Around 800 people die from liver disease every year in Scotland and the wards are full of liver failure in ways that they just weren’t two decades ago,” said John Dillon, MD, a consultant in gastroenterology and hepatology. “Liver disease is a silent killer, it creeps up on you. So it is crucial that we find a way to detect it earlier and switch off this ticking time bomb.”
Dillon and Ellie Dow, MD, consultant in biochemical medicine, worked with colleagues from the University of Dundee and NHS Tayside to develop the intelligent liver function tests (iLFTs) using the automated Blood Sciences laboratory infrastructure at Ninewells Hospital. The team created the new iLFTs which see more tests automatically carried out on a patient’s blood sample if there is a suspected liver disorder or abnormal results with no clear explanation.
Initial results from the trial showed a 44% increase in diagnosis of liver disease, giving patients earlier access to treatment. “In looking at a large set of patient data from Tayside we noticed abnormal liver function tests popping up that were not fully investigated,” according to Dillon. “All too often we were seeing patients dying of liver failure who had abnormal Liver Function Tests recorded years before when something could have been done. This stopped us in our tracks. We asked ourselves if these had been detected earlier, what difference could it have made?
“By applying variables to the existing IT systems in the lab, we were able to develop a system that detects the early warning signs of liver disease and which can then give GPs the tools they need to make a solid diagnosis and begin treatment plans. More importantly, our modification allows us to immediately differentiate between alcoholic or non-alcoholic fatty liver disease and the more rare diseases such as autoimmune liver diseases, Hepatitis C, or metabolic diseases, meaning those who need immediate assistance receive it faster.”
Since being launched in NHS Tayside in June last year more than 2,500 patients have been tested, with 30% of these showing abnormal results.
“We’ve been predicting that a liver failure epidemic has been coming but now we are seeing hard-evidence that it is already here,” continued Dillion, whose team published a study (“Intelligent Liver Function Testing (iLFT): A trial of automated diagnosis and staging of liver disease in Primary Care”), in the Journal of Hepatology. “We hope that, with continued tests, people drinking too much or eating high-fructose sugars can make the lifestyle changes now that will reduce the number of those coming into the hospital with fatal liver failure in the years to come.”
