Liver Disease: Likelihood Ratios

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 likelihood ratios of findings for Liver Disease are listed below. See the left navigation bar to change the display.

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Finding	+LR	-LR	Comments, Study
Albumin	3	0.7	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Apolipoprotein A	3.8	0.5	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Elevated Alkaline Phosphatase	3.8	0.4	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
Elevated ALT	5.6	0.5	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
Elevated AST	9.3	0.3	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 GGT	5	0.3	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
Elevated Total Bilirubin	6.2	0.5	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
Prealbumin (Transthyretin)	7.8	0.2	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Prothrombin Activity	5.8	0.4	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Pseudocholinesterase	2.3	0.4	Study: Digestion. 1987;37(2):72-8. PMID: 3622940
Serum Bile Acids	11.1	0.2	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