Research

Liver function tests in patients with hypertension in primary care: a prospective cohort study

Thuraiya Al Harthi, Penny Whiting and Jessica Watson
BJGP Open 2024; 8 (1): BJGPO.2023.0082. DOI: https://doi.org/10.3399/BJGPO.2023.0082

Article Figures & Data

Figures

  • Figure 1.
    Figure 1. Flow of participants through study. CPRD = Clinical Practice Research Datalink. LFT = liver function test.

    aLFT panel of two or more analytes that is defined as abnormal if any of the analytes not within the reference range. bThe date of the first liver function test done in 2015.

  • Figure 2.
    Figure 2. Test implications flowchart. Results that would be obtained if a hypothetical cohort of 1000 patients with hypertension were tested.

    FN = false-negative. FP = false-positive. LFT = liver function test. TN = true-negative. TP = true-positive.

Tables

  • Table 1. Baseline characteristics by liver function test panel of more than one analytea
    Abnormal LFT b Normal LFT b Total
    Number of patients, n (%)7918 (26.4%)22 082 (73.6%)30 000 (100%)
    Male, n (%)4267 (29.4%)10 257 (70.6%)14 524 (100%)
    Female, n (%)3651 (23.6%)11 825 (76.4%)15 476 (100%)
    Age, (median, IQR), years68.7 (78.1–59.0)69.8 (78.2–61.3)69.5 (78.2–60.6)
     <40 years, n (%)144/444 (32.4%)300/444 (67.6%)444 (100%)
     40–50 years, n (%)553/1885 (29.3%)1332/1885 (70.7%)1885 (100%)
     50–60 years, n (%)1457/4842 (30.1%)3385/4842 (70.0%)4842 (100%)
     60–70 years, n (%)2121/8296 (25.6%)6175/8296 (74.4%)8296 (100%)
     70–80 years, n (%)1999/8551 (23.4%)6552/8551 (76.6%)8551 (100%)
     >80 years, n (%)1644/5982 (27.5%)4338/5982 (72.5%)5982 (100%)
    Liver disease diagnosed in 1 year (n)9560155
    Incidence of liver disease within 1 year % (95% confidence interval)1.20% (0.97% to 1.46%)0.27% (0.21% to 0.35%)0.52% (0.44 % to 0.60%)

    • aBaseline characteristics including age, sex, and liver disease incidence sorted by LFT panel of more than one analyte.bLFT panel with more than one analyte is defined as abnormal if any of the analytes are not within the reference range. Of all 30 000 patients, 7918 (26.4%) had at least one abnormal test result, which was more frequent in males compared with females (P<0.001). The median age was 68.7 years in those with normal LFT and 69.8 years in abnormal test. For categorical age groups, a higher proportion of patients <40 years had abnormal tests compared with older age groups, P<0.001. CI = confidence interval.

    • IQR = interquartile range. LFT = liver function test.

  • Table 2. Diagnostic accuracy measures of liver function tests for liver disease diagnosis in patients with hypertension in primary care
    Liver function tests (analytes)Prevalence %(95% CI)Sens %(95% CI)Spec %(95% CI)PPV %(95% CI)NPV %(95% CI)DOR(95% CI)
    aLFT panel of two or more analytes performed simultaneously (n = 30 000)0.5(0.4 to 0.6)61.3(53.1 to 69.0)73.8(73.1 to 74.3)1.2(1.0 to 1.5)99.7(99.7 to 99.8)4.5(3.2 to 6.2)
    Albumin (n = 28 988)0.5(0.4 to 0.6)5.5 (2.4 to 10.6)94.5(94.2 to 94.8)0.5(0.2 to 1.0)99.5(99.4 to 99.6)1.0(0.5 to 2.0)
    Bilirubin (n = 29 189)0.5(0.4 to 0.6)8.0(4.2 to 13.6)96.2(95.9 to 96.4)1.1(0.6 to 1.9)99.5(99.4 to 99.6)2.2(1.2 to 3.9)
    Globulin (n = 11 557)0.4(0.3 to 0.6)2.1(0.1 to 11.1)94.6(94.2 to 95.0)0.2(0.0 to 0.9)99.6(99.4 to 99.7)0.4(0.0 to 2.1)
    TP (n = 18 376)0.4(0.4 to 0.5)6.2(2.0 to 13.8)97.4(97.2 to 97.6)1.0(0.3 to 2.4)99.6(99.5 to 99.7)2.5(1.0 to 5.9)
    ALP (n = 29 572)0.5(0.4 to 0.6)19.0(13.1 to 26.1)94.8(94.5 to 95.1)1.9(1.3 to 2.7)99.6(99.5 to 99.6)4.3(2.9 to 6.4)
    AST (n = 4294)1.0(0.7 to 1.4)47.2(30.4 to 64.5)95.1(94.4 to 95.8)8.9(5.3 to 13.9)99.4(99.1 to 99.7)17.4(8.9 to 33.8)
    ALT (n = 27 738)0.5(0.4 to 0.6)29.1(21.7 to 37.3)95.9(95.6 to 96.1)3.5(2.5 to 4.7)99.6(99.5 to 99.7)9.5(6.6 to 13.8)
    GGT (n = 8282)1.0(0.8 to 1.2)79.3(68.9 to 87.4)60.5(59.4 to 61.5)2.0(1.5 to 2.5)99.7(99.5 to 99.8)5.9(3.4 to 9.9)

    • aLFT panel of more than one analyte that is defined as abnormal if any of the analytes not within the reference range.

    • ALP = alkaline phosphatase. ALT = alanine aminotransferase. AST = aspartate aminotransferase. CI = confidence interval. GGT = gamma-glutamyl transpeptidase. LFT = liver function test. NPV = negative predictive value, probability of not having a target condition if test is negative. PPV = positive predictive value, probability of having a target condition if test is positive. Sens = sensitivity. Spec = specificity. TP = total protein.

  • Table 3. Types and frequency of liver diseases diagnosed within 1 year following liver function test
    Type of liver diseaseaLiver disease diagnosis (frequency)Frequency (%)
    Fatty liver diseaseNon-alcoholic fatty liver (66), Fatty change of the liver (50), Fatty liver (7), Alcoholic fatty liver (3)126 (81.3)
    Cirrhosis and liver fibrosisCirrhosis and chronic liver disease (9), Cirrhosis — non-alcoholic (1), Hepatic fibrosis (1), Portal hypertension (1)12 (7.7)
    Liver disease, unspecifiedb Liver disorder NOS (6), Acute liver failure (1), Hepatosplenomegaly (1)8 (5.2)
    Alcohol-related liver disease, othersc Alcoholic liver damage unspecified (2), Acute alcoholic hepatitis (1), Alcoholic fibrosis and sclerosis of liver (1), Alcoholic hepatitis (1)5 (3.2)
    ViralAcute hepatitis E (1), Hepatitis B (1)2 (1.3)
    AutoimmuneAutoimmune chronic active hepatitis (1), Primary biliary cirrhosis (1)2 (1.3)
    Total155 (100)

    • aLiver diseases were categorised based on disease pathology or underlying cause. bNo definitive liver diagnosis given. cLiver disease related to alcohol consumption other than alcoholic fatty liver.

    • NOS = not otherwise specified.

  • Table 4. Cascade effects within 6 months after testing using two or more analytes simultaneouslya
    Mean number of consultations per personb (95% CI)Mean number of referrals per person (95% CI)Mean number of total blood tests requested (95% CI)Mean number of appointments for blood testing in 6 months (95% CI)
    True-positive(n = 95)12.4 (10.5 to 14.3)c 1.6 (1.2 to 2.0)c 51 (36.9 to 65.1)c 4.7 (3.7 to 5.7)c
    False-negative(n = 60)10.3 (8.7 to 11.9)c 1.4 (0.8 to 2.0)c 33 (22.5 to 43.5)c 3.8 (2.9 to 4.7)c
    False-positive(n = 7823)10.5 (10.2 to 10.7)c 0.7 (0.6 to 0.7)c 29.8 (28.8 to 30.8)c 3.1 (3.0 to 3.2)c
    True-negative(n = 22 022)8.6 (8.5 to 8.7)c 0.6 (0.5 to 0.6)c 19.8 (19.3 to 20.2)c 2.3 (2.2 to 2.3)c

    • aLFT panel of more than one analyte that is defined as abnormal if any of the analytes not within the reference range. True-positives are patients with a positive test who develop target condition. False-positives are patients with a positive test without target condition. False-negatives are patients with a negative test who develop target condition. True-negatives are people with a negative test with no relevant disease. bIncludes face-to-face consultations, home visits, and telephone consultations. c P<0.001, comparing true-positives to false-negatives and false-positives to true-negatives

Supplementary Data

  • TAlH_10.3399BJGPO.2023.0082_supp.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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BJGP Open
Vol. 8, Issue 1
April 2024
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Liver function tests in patients with hypertension in primary care: a prospective cohort study
Thuraiya Al Harthi, Penny Whiting, Jessica Watson
BJGP Open 2024; 8 (1): BJGPO.2023.0082. DOI: 10.3399/BJGPO.2023.0082
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Intended for Healthcare Professionals
 
 

British Journal of General Practice