Stop n' Go: New 'Traffic Light' Test for Early Liver Disease Detection

A new "traffic light" test, developed by Dr Nick Sheron and colleagues at University of Southampton and Southampton General Hospital could find its way into primary care to diagnose liver fibrosis and cirrhosis in high risk populations, in a more effective way.

Liver disease typically develops silently, and without many discernible symptoms. Many people have no idea they are experiencing liver failure until it is too late. Roughly one third of those admitted to the hospital with end-stage liver disease die within a few months. This simple test could diagnose the disease much earlier, empowering those at risk to change their behavior and ultimately, save their lives.

The Southampton Traffic Light (STL) test, details of which are published in the September 2012 issue of the British Journal of General Practice (BJGP), combines several tests and clinical markers which are then scored and indicate a patient's likelihood of developing liver fibrosis and liver cirrhosis.

The test results manifest in three colors. Red means the patient has liver scarring (fibrosis) and may have developed cirrhosis. Green means there is no detectable cirrhosis and the patient isn't likely to die from liver disease in the next five years. Yellow means there is a 50/50 chance of scarring with the significant possibility of death within five years, and patients are then advised to stop drinking to prevent further disease and death.

The test was administered to 1,000 patients and their progress was carefully followed and monitored afterwards. In some cases, patients were monitored over the course of a few years to assess the accuracy of the test in predicting whether or not they have developed liver fibrosis or cirrhosis.

The test proved accurate in severe liver disease, and though not a substitute for clinical judgment or other liver function tests, it can provide general practitcioners with an objective method to accurately assess the severity of liver fibrosis in high-risk scenarios (heavy drinkers, those with type II diabetes, or the obese).

Dr Nick Sheron, lead author and Head of Clinical Hepatology at the University of Southampton, and consultant hepatologist at Southampton General Hospital, said: "We are reliant on general practitioners detecting liver disease in the community so they can intervene to prevent serious liver problems developing, but so far we haven't been able to give them the tools they need to do this. We hope that this type of test for liver scarring may start to change this because the earlier we can detect liver disease, the more liver deaths we should be able to prevent."

Study co-author and GP Dr Michael Moore said: "In primary care, minor abnormalities of existing liver tests are quite common but we struggle to know how best to investigate these further and who warrants specialist intervention. The traffic light test has the advantage of highlighting those at highest risk who should be investigated further and those in whom the risk is much lower where a watchful approach is more appropriate. This is not a universal screening test but if targeted at those in whom there is a suspicion of liver disease should result in a more rational approach to further investigation."The

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance added: "One of the challenges of liver disease, which is rising dramatically in this country, is the silent nature of the condition until it is often too late to reverse the damage. However, minor changes in standard liver blood tests are so common that it is difficult for GPs to know when to refer for specialist advice. This large study from Dr Sheron and colleagues in Southampton may prove really useful for guiding the right patients towards specialist care in a timely way."

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