A new type of test has been developed in Tayside which can detect liver disease at an early stage, potentially saving thousands of lives.
Consultant gastroenterologist and hepatologist Professor John Dillon and consultant in biochemical medicine Dr Ellie Dow worked with colleagues from NHS Tayside and the University of Dundee to develop the intelligent liver function tests (iLFTs) using the automated Blood Sciences laboratory infrastructure at Ninewells Hospital.
Liver function is routinely investigated by testing blood samples requested by GPs. Results commonly show abnormal liver function but this is often under investigated due to the many different and complex reasons for an abnormal result. This misses the opportunity to diagnose and treat liver disease at an early stage.
Using advances in laboratory technology, Professor Dillon and Dr Dow’s team created the new iLFTs which see more tests automatically carried out on a patient’s blood sample if there is a suspected liver disorder or abnormal results with no clear explanation.
GPs receive the results along with 32 potential outcomes, making it easier to identify the cause of liver dysfunction and give a firm diagnosis. This is complemented with lifestyle advice for those who need it, while those with advanced or complex disease are referred for further treatment.
Initial results from the iLFT trial showed a 44% increase in diagnosis of liver disease, giving patients earlier access to treatment.
Since being launched in NHS Tayside in June last year more than 2,500 patients have been tested, with 30% of these showing abnormal results. The tests have now been made standard practice across NHS Tayside and the Scottish Government’s Modern Outpatient Programme is considering the opportunities this might present, with work underway to determine whether there is potential to roll this out more widely across Scotland.
The innovative project was recognised with several prestigious awards in May including: Innovation in Practice Gold award at NHS Tayside STAR Awards 2019; Innovation award at Royal College of Physicians' Excellence in Patient Care Awards 2019; 2019 UNIVANTS of Healthcare Excellence Award; Frontline Gastroenterology Prize for the ‘Best patient benefit in gastroenterology and hepatology’; Innovation Award at the Royal College of Pathology Excellence Awards 2019; and Highly Commended in the Digital Innovation category of the BMJ Awards 2019.
Professor Dillon said, “We’ve been predicting that a liver failure epidemic has been coming but now we are seeing hard-evidence that it is already here. Around 800 people die from liver disease every year in Scotland and wards are full of patients with liver failure in ways that they weren’t two decades ago.
“What we are seeing now is a huge increase in the number of people with alcohol-related or obesity-related liver diseases, and at a far more advanced stage than previously predicted. We have also been surprised to see the number of people with significant liver scarring which is likely to become liver failure in 10 or 15 years’ time if we do not act now. Liver disease is a silent killer, it creeps up on you, so it is crucial that we find a way to detect it earlier and switch off this ticking time bomb.
“By working with the existing IT systems in the lab, we were able to develop a system that detects the early warning signs of liver disease and which can then give GPs the tools they need to make a solid diagnosis and begin treatment plans.
“More importantly, our modification allows us to immediately differentiate between alcoholic or non-alcoholic fatty liver disease and the more rare diseases such as autoimmune liver diseases Hepatitis C or metabolic diseases, meaning those who need immediate assistance receive it faster.
“We hope that with continued tests, people drinking too much or eating high-fructose sugars can make the lifestyle changes now that will reduce the numbers coming into hospital with fatal liver failure in the years to come.”
NHS Tayside consultant clinical biochemist and clinical lead for Biochemistry Dr Neil Greig said, “Given the prevalence of liver disease, the implications for this test across the UK are significant. I am proud to be colleagues with the team and cannot emphasise enough the impact that this innovation has on diagnosis and management of liver disease.”
Health Secretary Jeane Freeman said, “This is an innovative piece of work that is using technology to bring a real improvement to patients’ outcomes. Early detection is absolutely key to successful treatment. I would like to congratulate the team at the University of Dundee and NHS Tayside for their valuable work in this area.”
Dr Andrew Fraser from the Scottish Government’s Modern Outpatient Programme said, “For too long have we seen the rise in patients presenting with advanced liver disease which could have been picked up on routine tests at a much earlier stage. The Modern Outpatient Programme continues to support this innovative work in NHS Tayside, which will help to identify those at an early stage where directed intervention can prevent progression to end-stage liver disease.”