As an experiment, let's say that you are a person who cares about your health. Assume you know that liver disease is commonly asymptomatic or silent. It gives you no clue that it is dying until it is in bad shape. As an advocate for your own health, can you look at your own medical history and decide how likely it is that you need in depth diagnosis for the silent killer of cirrhosis?
There has been a lot of recent research on blood based screeners and the field is advancing rapidly. It is still early and the broad practice of primary care medicine has not yet started using the best information available routinely. However, we now know that we can look at something more than just whether AST and ALT are elevated as guides to advancing liver disease. It is important to understand that high levels of these tests indicate that a lot of liver damage is occurring. What you want to know is are you at risk of being in that situation even though you have no symptoms.Read more
Online tools can help you understand the risks of liver disease.
Only a doctor can diagnose a liver disease and it is complex, but if you, as a patient, are better informed your ability to understand the diagnosis and to ask the right questions will enable you to have a better dialog with your doctor. We off these screeners as a tool you can use to better prepare yourself to engage with your physician in diagnosis any potential illness.
This first screener looks at very simple characteristics, such and your age and weight, and calculates whether you are probably in a low or high risk group. It isn't a medical test and just compares your values with the larger population but it can help you understand where you fall on the probability curve compared to the average person. It is useful for people who are just learning about liver health. It is not useful for anyone who has had more specific testing and knows more about their health, but you have to start somewhere if you want to learn about liver disease. It can help you understand questions you should ask your doctor.
The next level of screening test looks at specific lifestyle habits and general characteristics to provide a somewhat more refined probability of what your liver health is. Like the first screening this compares you to the general society so it is not a diagnostic test but can give you a sense of how high you risk might be and help you discuss your specific situation with your doctor.
Blood tests and screening calculators can't diagnose liver disease for you, but they can be useful to help you understand what your probability of having liver disease might be and may prompt you to consult your doctor even though you may still feel well.
More sophisticated online calculators are available which use readily available blood tests and physical characteristics. Nothing personal about you is recorded or becomes part of any record so this is just information for you as a patient to be better informed. Research has shown that the NFS and FIB-4 are useful to help rule out advanced disease. They can provide some guidance to help you think about it and suggest next steps. They don't prove anything about your diagnosis of possible disease, but they can be a guide to the next steps needed to arrive at a diagnosis.
From the tables below you can see how they are applied. They describe high and low cutoffs which have been shown to provide useful guidance about liver status. They are not not ideal but are a guide to suggest broadly how to view liver health and can help point the way to next steps. These are not yet commonly used by your primary care doctor but there is a movement underway to make these tests part of determining whether a patient should be quickly referred to a specialist even if there are no symptoms of liver disease.
If you find that you have a high probability of disease it would be wise to see your doctor. If indeterminate, you need more information. If your probability is low it is reasonable to be watchful but doesn't suggest that you need to see your doctor soon unless you have symptoms. Any information like this must be weighed in light of all of your other health data as no single snapshot can give you a definitive answer. We offer these to help you understand the general picture as you seek to learn your individual status. Remember advancing liver disease often has no symptoms.
Recent research has shown that these common blood tests combined with Fibroscan screening improves the accuracy of NASH staging. This is important information which comes from the STELLAR trials. Here is a quote and a link to the analysis.
Fibrosis-4 index followed by measurement of liver stiffness with vibration-controlled transient elastography or Enhanced Liver Fibrosis test maintained acceptable noninvasive performance in identifying advanced fibrosis due to nonalcoholic steatohepatitis while reducing the rate of indeterminate results, according to an analysis of the STELLAR trial outcomes.
Other, more sophisticated blood tests are being developed and we will add them here as they become available.