Majority of patients with liver disease contact their clinicians once they have advanced cirrhosis or acute decompensation. The main screening tests used for diagnosing liver diseases are liver function tests (LFTs). Moreover, the published data assessing laboratory values with biopsy-proven stages of hepatic fibrosis are scarce. The authors of the present study determined the existence of an association between routine LFTs and stages of hepatic fibrosis.

This large retrospective observational study included 771 liver biopsies that assessed the stage of fibrosis with the help of AST, ALT, INR (International Normalized Ratio), BUN (blood nitrogen urea), creatinine, platelets, alkaline phosphatase, bilirubin, and albumin. Mean and 95% confidence intervals were used to define the distributions of serum markers in different fibrosis stages. The authors used multivariable generalized linear models and a two-tailed P-value was evaluated.

The results indicated that ALT was not statistically remarkable for any stage, while AST was statistically significant for stage 3 and 4 fibrosis. Although INR was statistically relevant only in stage 4 disease, it persisted near the upper limit of normal range. No clinical significant correlation was found with albumin. All stages of fibrosis showed platelets within normal laboratory range. The remaining laboratory values did not show statistical and clinical relevance.

Thu, it can be concluded that there is emerging trend in increased health care burden from chronic liver disease (CLD). The significant management to the issue lies in the awareness of clinicians that asymptomatic patients with liver disease may exhibit normal or near normal laboratory findings. The prompt recognition of asymptomatic patients offer a window for treatment with new promising modalities, which in turn can lead to decrease morbidity and mortality from CLD. 

Source: Ahmed Z, Ahmed U, Walayat S, et al. Liver function tests in identifying patients with liver disease. Clin Exp Gastroenterol. 2018;11:301-307. Published 2018 Aug 23.