Evidence map›Paper›PMID 38934697›Full record

ArticleHepatology communications2024

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit.

David S Prince, Shakira Hoque, Christy Kim, Salim Maher, Jane Miller, Phoebe Chomley, Janice Pritchard-Jones, Sally Spruce, Nathan McGarry, David Baker and 6 more

Abstract read
In one paragraph

Article in Hepatology communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

David S PrinceAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.ORCID 0000-0001-8087-0548
Shakira HoqueDepartment of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia.
Christy KimDepartment of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia.
Salim MaherAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.ORCID 0000-0002-2579-5925
Jane MillerCentral and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia.
Phoebe ChomleyCentral and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia.
Janice Pritchard-JonesAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Sally SpruceAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Nathan McGarryDepartment of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia.
David BakerEast Sydney Doctors Darlinghurst, New South Wales, Australia.
Penelope ElixFountain Street General Practice, Alexandria, New South Wales, Australia.
Ken LiuAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.ORCID 0000-0002-0453-3168
Simone I StrasserAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.ORCID 0000-0001-6374-1525
Brendan GoodgerCentral and Eastern Sydney Primary Health Network, Mascot, New South Wales, Australia.
Amany ZekryFaculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0002-5675-1810
Geoffrey W McCaughanAW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.ORCID 0000-0002-1483-1636

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIdentifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression.

methodsA cloud-based software solution ("the Liver Toolkit") was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded.

resultsExisting laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0-9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction-associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041).

conclusionsThis novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.

Indexed as

Elasticity Imaging TechniquesGeneral PracticeAdultAgedAspartate AminotransferasesChronic DiseaseFemaleHumansLiver CirrhosisLiver DiseasesMaleMass ScreeningMiddle AgedPlatelet CountSoftwareAspartate Aminotransferases

Identifiers

PMID38934697
PMCPMC11213595

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.