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28-08-2012 | General practice | Article

‘Traffic light’ test unmasks liver harm

Abstract

Free abstract

medwireNews: GPs could soon be offering patients a colour coded blood test to check for hidden liver damage due to drinking above-recommended levels of alcohol.

The "Southampton Traffic Light" test gives three colour-coded results, with green indicating that liver damage is unlikely, amber at least a 50:50 chance that the patient has liver scarring (fibrosis) and red that the patient has scarring and possibly even cirrhosis.

Southampton University researchers led by Dr Nick Sheron describe how they developed the test in the latest issue of the British Journal of General Practice. The team devised an algorithm for the prediction of liver damage that combines two serum markers of fibrosis, procollagen-3 N-terminal peptide (P3NP) and hyaluronic acid (HA), with platelet count.

In secondary care liver patients, the team reports, a red test result predicted fibrosis and possible cirrhosis, while a green result accurately ruled out cirrhosis and was moderately good at ruling out fibrosis. Over an average of 4 years of follow-up, 14% of patients with a red result died, as did 3.3% of those with an amber result, whereas none of those with a green result died. Dr Sheron and team suggest that in primary care, patients with a red result would be referred for further evaluation, while those with an amber test result, suggesting possible fibrosis, would be told to cut out alcohol and be retested in 3 years. Those with a green result in whom fibrosis is unlikely would be retested after 3-5 years if risk factors persist.

Study co-author and GP Dr Michael Moore explained: "Minor abnormalities of existing liver tests are quite common but we struggle to know how best to investigate these further and who warrants specialist intervention. The traffic light test has the advantage of highlighting those at highest risk who should be investigated further and those in whom the risk is much lower where a watchful approach is more appropriate.

"This is not a universal screening test but if targeted at those in whom there is a suspicion of liver disease should result in a more rational approach to further investigation."

medwireNews (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price