Liver problems in people in the UK and internationally are becoming increasingly common, but are difficult to identify early in the course of the disease. As the liver becomes more diseased scaring forms within it (fibrosis) and this is termed advanced liver disease.
We intend to look at how frequently general practitioners are measuring common liver blood tests. We would expect the numbers to be rising given the increase in disease and the focus on the liver as a priority disease for early diagnosis.
Firstly, we plan to use general practice data (CPRD) to determine how often a number of different liver blood tests are measured and how this has changed over time.
Secondly we plan to look as see if these tests are performed more frequently in patients known to be at high risk of liver disease people with type 2 diabetes, obesity or excess alcohol consumption.
The results will help us decide if it would be possible to integrate advanced liver blood testing and screening for liver disease into UK general practice. Guiding the future healthcare of patients.
Overall aim:
To understand the temporal changes in individual liver function testing over the period 1997 to most recent in UK general practice in order to inform potential screening practices.
Methodology:
We will determine the prevalence of blood marker testing in the adult UK population over time for each of the following assays using CRPD: aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, albumin and platelet count. Results will be stratified by subgroups of the population with or at high risk of chronic liver disease: type 2 diabetes, obesity, alcohol excess. We will also determine the frequency of abnormal results.
Annual prevalence rates for each marker will be determined by extracting laboratory measures or READ codes from the linked clinical file to determine their levels.
Subgroups will be determined using validated READ codes.
Temporal trends in marker testing using age and sex standardised rates of each test use will be analysed using a join point regression to look for statistically significant changes in rates of marker testing use over the study period and to determine change points in the trends.
Scientific and medical opportunities:
This research will improve the applicability and reliability of clinical guidelines for the diagnosis of CLD in primary care.
Liver enzymes and function tests (detailed in section N).
Joanne Morling - Chief Investigator - University of Nottingham
Joanne Morling - Corresponding Applicant - University of Nottingham
Joe West - Collaborator - University of Nottingham
Polly Scutt - Collaborator - University of Nottingham
Timothy Card - Collaborator - University of Nottingham
Yusef Alenezi - Collaborator - University of Nottingham