As part of ongoing work to identify patients at increased risk of significant liver disease, the Biochemistry Department, in conjunction with the Liver Unit will be launching a new tool to evaluate the likelihood of underlying fibrotic change in patients presenting with raised ALT. This tool will involve automatic measurement of serum AST in all primary care patients in whom ALT is raised for the first time and the calculation of an AST:ALT ratio. A comment advising the requester to refer to the liver plan pathway for guidance on further management will be appended to all results. Patients with a ratio ≥1 are considered to be at increased risk of developing significant liver disease, irrespective of the degree to which their ALT is elevated, while those with a ratio <1 are at low risk.

Dr Andrew Yeoman, Consultant Hepatologist, has devised an algorithm based on a combination of AST:ALT ratio, ALT concentration and relevant underlying diagnoses e.g. alcohol excess, obesity and the metabolic syndrome, to guide on further investigation and management (attached below). The algorithm will also be available on the Clinical Biochemistry Home Page http://howis.wales.nhs.uk/sitesplus/866/page/40863 and can be found in the ABUHB Pathology Handbook http://wphtrak.wales.nhs.uk/dept.cfm?t=8 by searching for LFT, AST or ALT and following the external link.

This service will be launched on Monday the 4th of July. However, as this is a work in progress the algorithm may be adjusted following a 3 month pilot period, during which we will be evaluating how well this approach identifies the target population.