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We read with interest the recent article by Newsome et al which provides guidelines for general practitioners on the management of abnormal liver blood tests based on the clinical recognition pattern of elevated liver enzymes and recommendations on non-invasive laboratory based liver fibrosis scores such as Fibrosis-4 (FIB-4) to exclude advanced fibrosis.1 Patients with low FIB-4 values should be managed in primary care, those with intermediate test results receive further diagnostics by an enhanced liver fibrosis test or ultrasound based elastography methods while those with high FIB-4 score are directly referred to secondary care. Newsome’s recommendations are especially relevant for non-alcoholic fatty liver disease (NAFLD), the most common aetiology of elevated liver enzymes in the primary care setting in the Western world.2 In NAFLD, the key predictor for liver related outcome and mortality is liver fibrosis.3 4 In Germany by the year 2030, 17 million NAFLD patients will present without fibrosis, but …
Contributors Authors contributions: Concept of the study: DP and JW. Provision of laboratory data: OB, KJ and JK. Data analysis: DP, OB, KJ, JK, TB and JW. Preparation of the manuscript: DP and JW. Revision of the manuscript: DP, OB, KJ, JK, TB and JW.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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