Swedish scientists analyzed how having a blood test every few years can help predict one's chances of developing liver cirrhosis. Blood levels are then calculated by the Fibrosis-4 (FIB-4) Index for Liver Fibrosis.
The new study by the Karolinska Institutet in Sweden analyzed statistics from the Swedish Apolipoprotein Mortality Risk (AMORIS). The blood samples of 812,073 patients had regular blood sampling between 1985 and 1996.
A blood tests ever five years would help identify the increased risk of liver disease for those in the low-risk group. However, those already at immediate risk of cirrhosis seemed to have low risk of absolute liver disease despite repeated testing, which could result in false positive results.
To narrow down some of the data, the team excluded people with a history of severe liver disease and those with liver damage as a result of alcohol or drug abuse. Removing these data would prevent results from having high false laboratory tests since they were already at risk of liver cirrhosis.
Liver Disease
Liver cirrhosis is a disease that is commonly caused by chronic alcoholism, hepatitis B, and hepatitis C. The liver becomes scarred, also known as fibrosis, as the liver tries to self-repair when it is suffering from injury or disease.
Another cause is nonalcoholic fatter liver disease, which is common for those with diabetes and obesity. Other causes may be problems with the bile ducts, or the tubes connecting the liver to the small intestine, in the form of primary biliary cirrhosis, primary sclerosing cholangitis, or biliary atresia. Symptoms usually occur at a late stage where the only treatment is a liver transplant.
'It is difficult to predict the risk of cirrhosis, although you can get some guidance in using regular blood tests that measure liver damage," said hepatologist Hannes Hagstrom from the Karolinska University Hospital. 'Therefore, we wanted to investigate whether what is known as the FIB-4 score can increase the accuracy of the identification of people at high risk, in particular with information from repeated measurements.'
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Regular Blood Tests
Blood samples taken every few years and measured by the FIB-4 score would increase the chances of predicting future liver damage compared to one-time testing. Indicators of liver disease can be found in the blood count, plasma proteins (proteins in the blood), and hepatic enzymes, or enzymes in the liver which help indicate if its cells are injured or inflamed.
Although the data from AMORIS only measured blood tests in a period of 11 years, those that continued regular blood tests in national registers helped identify individuals who developed liver disease up to 27 years later. The study noted how FIB-4 scores that rose between two testing times and then decrease when it falls helped resulted in identify almost 50% of individuals developing cirrhosis.
'We show that this biomarker is useful for identifying people in primary care with an increased risk of cirrhosis who may need to be more carefully investigated and to exclude people who do not need this,' said Dr. Hagstrom. 'But the method needs to be further developed to reduce the risk of false-positive findings, which can lead to unnecessary examinations in healthy people.'
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