Liver Disease: Sensitivity and Specificity

Introduction: Liver disease can have many etiologies, including acute and chronic viral hepatitides (Hepatitis B and Hepatitis C), Alcoholism, obesity, and autoimmune disorders. "Liver function tests" or LFTs reflect hepatitis, and there are two major categories of LFTs: synthetic outputs of the liver (albumin, coagulation factors, etc.) and hepatocyte enzymes (aminotransferases).

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The sensitivity and specificity of findings for Liver Disease are listed below. See the left navigation bar to change the display.

Specific Findings

Finding	Sensitivity	Specificity	Comments, Study
Serum Bile Acids	78%	93%	Sensitivity for Cholestasis = 54% (mild), 98% (severe) Sensitivity for Parenchymal dz = 42% (mild), 90% (severe) Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534
Elevated AST	74%	92%	Sens for Cholestasis = 28% (mild), 88% (severe) Sens for Parenchymal = 70% (mild), 85% (severe) Note that AST (but not ALT) is often elevated in MIs, though this particular study found the specificity of AST and ALT to be the same in patients with MI. Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534
Elevated Total Bilirubin	56%	91%	Sens for Cholestasis = 26% (mild), 85% (severe) [much more sensitive for extrahepatic cholestasis] Sens for Parenchymal = 18% (mild), 68% (severe) Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534
Elevated ALT	56%	90%	Sens for Cholestasis = 26% (mild), 77% (severe) Sens for Parenchymal = 58% (mild), 58% (severe) Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534
Prealbumin (Transthyretin)	84%	89.2%	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Prothrombin Activity	63%	89.2%	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Apolipoprotein A	53.4%	86.1%	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Albumin	41.6%	85.9%	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Elevated GGT	75%	85%	Sens for Cholestasis = 54% (mild), 84% (severe) [much more sensitive for extrahepatic cholestasis] Sens for Parenchymal = 70% (mild), 82% (severe) Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534

Poorly Diagnostic Findings

Elevated Alkaline Phosphatase

65%

83%

Sens for Cholestasis = 53% (mild), 92% (severe)

Sens for Parenchymal = 29% (mild), 72% (severe)

Study: Dig Dis Sci. 1983 Feb;28(2):129-36. PMID: 6825534

Pseudocholinesterase

69.8%

Study: Digestion. 1987;37(2):72-8. PMID: 3622940