Chronic Liver Disease (CLD) often develops quietly over many years, and many people don’t know they have it until serious damage has already occurred. CLD accounts for approximately 2 million deaths annually. CLD and cirrhosis can have major health consequences, including liver failure and life-threatening complications. Blood tests called liver function tests are among the most commonly use in routine healthcare, but abnormal results are not always followed up in a systematic way to support early diagnosis.
This new study, published in Hepatology Communications, evaluated whether a new way of processing these routine tests could improve early detection of liver disease and cirrhosis. Instead of relying on individual clinical judgement alone, this research looked at a structured pathway designed to make better use of results that are already being collected every day.
Lead author, Research Officer & Data Scientist, Jingwei Gao, in Population Data Science at Swansea University, summarises the research and findings.
Why Is This Research Needed?
Chronic liver disease is becoming more common, driven by factors such as obesity, diabetes, and alcohol use. In many cases, early stages of liver disease cause no symptoms, and routine abnormal liver test results may not be followed up systematically. This means that some people with early liver damage are not identified until the disease is advanced, which reduces the chances of timely management and monitoring.
The lack of consistent pathways for interpreting and acting on common blood test results has been recognised as a potential barrier to early detection. This study was designed to test whether a practical change within laboratory reporting could lead to more people being diagnosed earlier, without requiring new tests or expensive equipment.
What Are the Aims of This Research?
The main goal of the study was to see if introducing a structured liver function test pathway would increase how often chronic liver disease and cirrhosis were diagnosed, compared with areas that continued with standard practice.
The pathway included automatic follow-on testing when initial results suggested possible liver problems, and automated reporting of an enzyme ratio that can signal liver damage. The researchers examined data from two regions in Wales where this pathway was introduced and compared them with areas that did not use it. The analysis covered January 2010 to December 2023, allowing a long-term view of how diagnosis patterns changed over time.
How Was SAIL Databank Used in the Research?
The study used data from the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University; a secure, national infrastructure for data research that holds anonymised health records for millions of people in Wales. This included laboratory results, general practice records, and hospital diagnoses.
Using SAIL allowed the research team to identify almost 79,000 people who had liver disease during the study period and follow their health records over time. Because the data are linked across sources and cover the whole population, the researchers could compare trends in diagnosis between regions with and without the new pathway. This approach provides strong evidence about real-world effects, rather than relying on a small clinical trial.
What Is the Anticipated Impact of the Research?
The results showed that the new liver function test pathway was associated with a significant increase in cirrhosis diagnoses in both regions where it was introduced. In the first region, the rate of cirrhosis diagnosis increased by 24% compared with control areas, and in the second region by 16%. These increases were statistically significant, meaning they are unlikely to be due to chance.
In one of the regions, the overall rate of chronic liver disease (including cirrhosis) diagnoses also increased temporarily after introducing the pathway, with an incidence rate indicating a 35% higher rate than in control areas during that period.
These findings suggest that a relatively simple change to how routine blood tests are followed up can help identify more people with serious liver disease. Because the pathway uses tests already ordered in everyday care, it could potentially be adopted widely, as it relies on tests already used in routine care. Earlier diagnosis may lead to better opportunities for lifestyle changes, monitoring, and treatment, potentially reducing the burden of advanced liver disease for individuals and health services.
Wider adoption of such pathways and continued evaluation could help health systems detect liver disease earlier, improve patient outcomes, and inform strategies to manage a growing public health challenge.
Dr Thomas Peter Ignatius Pembroke
Consultant Hepatologist at University Hospital of Wales, and Hon. Senior Research Fellow at Cardiff UniversityAbstract
Acknowledgements
The research was conducted with colleagues at Swansea University, Cardiff University and Cardiff and Vale University Health Board. The full paper, including the complete author list and affiliations, can be accessed here:
The authors acknowledge all the data providers who make anonymised data available for research. The authors also acknowledge Dr Andrew Yeoman (Royal Gwent Hospital) for his contribution to discussions related to this research.
The Liver Disease Cymru Partnership (LDCP) received a grant from the National Institute for Health Research. This research was partly funded by an unrestricted grant from the Liver Disease Implementation Group, Welsh Government.
