Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Abstract

BackgroundLiver disease develops silently and presents late, with often fatal complications.

Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

“…An elevated ALT is related to the degree of fatty infiltration in the liver but has no discrimination for identifying subjects with progressive liver fibrosis or cirrhosis. 7 In recent years a range of new liver diagnostic technologies have been introduced into secondary care which can detect the fibrosis directly, and the study hypothesised that these non-invasive tools could be used in primary care to detect early liver disease when risk reduction could prevent the development of serious liver disease. With this aim in mind the study developed the Southampton Traffic Light (STL) test, 7 a relatively inexpensive (£50) blood test which combines two well-established markers of liver fibrosis, hyaluronic acid, and collagen P3NP, together with platelet count as a measure of portal hypertension.…”

“…The study recently published follow-up data in more than 1000 subjects who had the STL, followed for up to 9 years, showing that categorisation of STL into three risk groups initially termed: strong positive/positive/negative had good prognostic accuracy. 7 The grades were modified to red/amber/green traffic light results during the course of the study.…”

“…In the liver clinic population in whom the test was developed, a red STL grade had a positive predictive value (PPV) for liver fibrosis of 96% and for cirrhosis of 69%, the lower prevalence of liver fibrosis in the community would reduce e702 British Journal of General Practice, October 2013 the PPV somewhat but the study estimates that between one-half and three-quarters of these 'red' individuals have a significant degree of liver fibrosis. 7 The study obtained a follow-up AUDIT in 77% of those attending for traffic light tests, of whom 42% reduced their drinking by at least one AUDIT hazard grade, either from hazardous (AUDIT 8-15) to low risk, or from harmful/dependent (AUDIT >15) to hazardous. Although it is unlikely that subjects who failed to return the follow-up AUDIT were all 'intervention fails', in this sensitivity analysis of all cases the proportion of patients cutting alcohol reduced from 42% to 33%.…”

“…All blood tests were performed as routine tests in the NHS clinical biochemistry and haematology labs at University Hospital Southampton using assays as previously described. 7 All patients with an AUDIT score ≥8 (those hazardous and harmful drinkers) were given written information, Alcohol and Sensible Drinking. 11 This leaflet was used as the control intervention in the current trial of brief intervention by the National Brief Intervention Research Consortium recently funded by the Department of Health.…”

Alcoholic liver disease – the extent of the problem and what you can do about it

“…Surrogate markers of fi brosis including hyaluronic acid and procollagen 3 N-terminal peptide (P3NP) can also detect fi brosis, and reduce harmful drinking through their incorporation into the Southampton traffi c light grades. 32 Risk factor identifi cation is an alternative tool to detect liver disease in the community. Primary care is in a strong position to identify this group, as patients with alcohol dependency make frequent GP visits and liver disease shares lifestyle risk factors already monitored by GPs in annual cardiac, renal and diabetic checks.…”