Should Patients with Abnormal Liver Function Tests in Primary Care be Tested for Chronic Viral Hepatitis

David T Arnold; Louise M Bentham; Ruth P Jacob; Richard J Lilford; Alan J Girling


BMC Fam Pract 

In This Article


This analysis indicates that the strategy of repeating LFTs in asymptomatic patients, advocated by current guidelines, is less sensitive and far more expensive than viral testing those patients born in countries where viral hepatitis is prevalent. Despite few cases of viral hepatitis the data on costs of the various strategies is strong and the results of prevalence rates within the cohort are consistent with other literature. The finding that a notably raised ALT level was also effective at identifying infected patients inspired the construction of a "fast and frugal" heuristic that might aid GPs who are faced with abnormal LFTs in asymptomatic patients, with regards to viral hepatitis. Our proposal addresses the diagnostic problem by identifying a clear high-risk population originating in prevalent countries. The residual population who are not immigrants from such countries are at low risk. However, this should not override clinical judgement. Its overall cost in other settings will depend on the relative proportions of patients in these risk-strata, but our results suggest that the cost of automatic testing of high-risk individuals will be repaid in terms of additional cases detected.

Clearly the situation might change as vaccination catches on in developing countries and needle hygiene improves. The key points to emerge are that:

1) it is more efficient to determine country of origin with a view to viral testing, than to simply repeat the LFT;
2) it is more cost-effective to test the whole LFT positive population for viral hepatitis, than to repeat the LFT with a view to viral testing if it remains positive.