A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis

Gao, Jingwei, Ahmed, Haroon ORCID: https://orcid.org/0000-0002-0634-8548, Cannings-John, Rebecca ORCID: https://orcid.org/0000-0001-5235-6517, Akbari, Ashley, Davies, Aled and Pembroke, Thomas Peter I. 2026. A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis. Hepatology Communications 10 (2) , e0887. 10.1097/HC9.0000000000000887

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Abstract

Background: To enhance early liver disease detection, a clinical pathway integrating reflex AST testing and automated AAR reporting was implemented. We aim to evaluate the long-term effectiveness of introducing reflex AST testing by assessing its impact after implementation in 2 regions of Wales. Methods: We applied a quasi-experimental, Difference-in-Difference approach to evaluate the introduction of the reflex AST:ALT pathway in Wales (January 2010 to December 2023). Outcomes were the monthly incidence rate of (1) chronic liver disease (including cirrhosis) and (2) cirrhosis in the 2 intervention regions versus the control regions. Results: In total, 78,917 individuals with liver disease were included in the study. A significant increase in cirrhosis diagnoses was observed in both regions (first region: incidence rate ratio=1.24, 95% CI: 1.15–1.34, p<0.001; second region: incidence rate ratio=1.16, 95% CI: 1.02–1.33, p=0.028). The incidence of composite chronic liver disease (including cirrhosis) increased transiently in the second region only (incidence rate ratio=1.35, 95% CI: 1.16–1.56, p<0.001). Conclusions: In this long-term, population-level evaluation, reflex AST:ALT testing increased cirrhosis detection in both regions and produced a short-term rise in chronic liver disease (including cirrhosis) diagnoses one region, strengthening the evidence of the pathway’s effect on cirrhosis detection. Further study is warranted to understand regional variation.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Date of First Compliant Deposit:	4 February 2026
Date of Acceptance:	10 November 2025
Last Modified:	04 Feb 2026 10:15
URI:	https://orca.cardiff.ac.uk/id/eprint/184387

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