{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:46:26Z","timestamp":1758861986332,"version":"3.40.5"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T00:00:00Z","timestamp":1616803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Liver disease mortality rates continue to rise due to late diagnosis. We need noninvasive tests to be made available in the community that can identify patients at risk from a serious liver\u2010related event (SLE). We examine the performance of a blood test, the liver traffic light test (LTLT), with regard to its ability to predict survival and SLEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using routinely gathered clinical data, sequential LTLT test results from 4854 individuals with suspected liver disease were prospectively analyzed (median follow\u2010up 41\u2009months). An SLE was defined as the development of cirrhosis, liver failure, ascites, or varices. Patients were graded as follows: red (high risk), amber (intermediate risk), and green (low risk).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 565 individuals experienced an SLE (11.6%). The area under the curve (AUC) for the continuous LTLT variable was 0.87 (95% confidence interval 0.85\u20130.89) for prediction of an SLE and 0.81 (0.78\u20130.84) for mortality. When categorized into red\/amber\/green grades, a red LTLT result predicted an SLE with negative and positive predictive values of 0.97 and 0.29, respectively. A red LTLT score predicted mortality with negative and positive predictive values of 0.98 and 0.18, respectively. Kaplan\u2013Meier plots demonstrated increased mortality and SLEs in the red group <jats:italic>versus<\/jats:italic> the green and amber groups (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and an increase in SLEs in the amber <jats:italic>versus<\/jats:italic> green group (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Here, the LTLT is further validated for the prediction of survival and SLE development. The LTLT could aid primary care risk management and referral pathways with the aim of detecting and treating liver disease earlier in the general population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12460","type":"journal-article","created":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T09:46:35Z","timestamp":1616838395000},"page":"549-557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Validation of the liver traffic light test as a predictive model for survival and development of liver\u2010related events"],"prefix":"10.1002","volume":"5","author":[{"given":"Rochelle","family":"Sylvester","sequence":"first","affiliation":[{"name":"Department of Medicine Southampton University Hospitals NHS Foundation Trust  Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7768-6886","authenticated-orcid":false,"given":"Theresa J","family":"Hydes","sequence":"additional","affiliation":[{"name":"Department of Medicine Southampton University Hospitals NHS Foundation Trust  Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Hales","sequence":"additional","affiliation":[{"name":"AH IT Solutions  Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Williams","sequence":"additional","affiliation":[{"name":"Institute of Hepatology, Foundation for Liver Research King's College London  London UK"},{"name":"Faculty of Life Sciences and Medicine King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Sheron","sequence":"additional","affiliation":[{"name":"Institute of Hepatology, Foundation for Liver Research King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32866-0"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32234-6"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.09.027"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp12X654588"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X673711"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208798"},{"key":"e_1_2_6_9_1","unstructured":"Siemens.Siemens. The ELF\u2122 Blood Test \u2010 Setting A New Standard for Liver Fibrosis Assessment 2019. Available from URL:https:\/\/www.siemens-healthineers.com\/en-uk\/laboratory-diagnostics\/assays-by-diseases-conditions\/liver-disease\/elf-test"},{"volume-title":"Non\u2010Alcoholic Fatty Liver Disease (NAFLD): Assessment and Management","year":"2016","author":"National Institute for Health and Care Excellence","key":"e_1_2_6_10_1"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.09.008"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0095776"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27389"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-302514d.273"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.203166"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12813"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e3181cb4216"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.2463\/mrms.2012-0052"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12013-014-0275-z"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27069"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12307"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.04.023"},{"volume-title":"Cirrhosis in Over 16s: Assessment and Management","year":"2016","author":"National Institute for Health and Care Excellence","key":"e_1_2_6_23_1"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690557"}],"container-title":["JGH Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12460","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgh3.12460","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12460","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T18:30:48Z","timestamp":1693420248000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgh3.12460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,27]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1002\/jgh3.12460"],"URL":"https:\/\/doi.org\/10.1002\/jgh3.12460","archive":["Portico"],"relation":{},"ISSN":["2397-9070","2397-9070"],"issn-type":[{"type":"print","value":"2397-9070"},{"type":"electronic","value":"2397-9070"}],"subject":[],"published":{"date-parts":[[2021,3,27]]},"assertion":[{"value":"2020-10-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}