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.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Elevated Alkaline Phosphatase	+ 0 -	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	+ 0 -	69.8%	69.8%
Study: Digestion. 1987;37(2):72-8. PMID: 3622940

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Serum Bile Acids	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	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)	+ 0 -	84%	89.2%
Study: Digestion. 1987;37(2):72-8. PMID: 3622940
[ + ] Prothrombin Activity	+ 0 -	63%	89.2%
Study: Digestion. 1987;37(2):72-8. PMID: 3622940
[ + ] Apolipoprotein A	+ 0 -	53.4%	86.1%
Study: Digestion. 1987;37(2):72-8. PMID: 3622940
[ + ] Albumin	+ 0 -	41.6%	85.9%
Study: Digestion. 1987;37(2):72-8. PMID: 3622940
[ + ] Elevated GGT	+ 0 -	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