{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:51:56Z","timestamp":1787241116968,"version":"build-2736575974"},"reference-count":45,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","theclinics.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Primary Care: Clinics in Office Practice"],"published-print":{"date-parts":[[2023,9]]},"DOI":"10.1016\/j.pop.2023.03.007","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T03:29:08Z","timestamp":1684207748000},"page":"363-376","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":6,"title":["Approach to Elevated Liver Enzymes"],"prefix":"10.1016","volume":"50","author":[{"given":"Jessica","family":"Rosenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orlando","family":"Sola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Visconti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MEG.0000000000000233","article-title":"A\u00a0systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes","volume":"27","author":"Radcke","year":"2015","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"7281","key":"10.1016\/j.pop.2023.03.007_bib2","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1136\/bmj.322.7281.276","article-title":"How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact","volume":"322","author":"Sherwood","year":"2001","journal-title":"BMJ"},{"issue":"6","key":"10.1016\/j.pop.2023.03.007_bib3","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.amjms.2018.02.005","article-title":"Assessing the Burden of Abnormal LFTs and the Role of the Electronic Health Record: A Retrospective Study","volume":"355","author":"Schreiner","year":"2018","journal-title":"Am J Med Sci"},{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib4","first-page":"234","article-title":"Presence and severity of non-alcoholic fatty liver disease in a large prospective primary care cohort","volume":"56","author":"Armstrong","year":"2012","journal-title":"J\u00a0Histotechnol"},{"issue":"3","key":"10.1016\/j.pop.2023.03.007_bib5","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/j.1365-2036.2011.04724.x","article-title":"Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"key":"10.1016\/j.pop.2023.03.007_bib6","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/apt.14327","article-title":"Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross-sectional analysis of 2011-2014 National Health and Nutrition Examination Survey","volume":"46","author":"Wong","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"10.1016\/j.pop.2023.03.007_bib7","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1001\/jama.2019.2276","article-title":"Prevalence of alcoholic fatty liver disease among adults in the United States","volume":"321","author":"Wong","year":"2019","journal-title":"JAMA"},{"key":"10.1016\/j.pop.2023.03.007_bib8","unstructured":"Yoon YH and Chen CM, Surveillance Report #105. Liver cirrhosis mortality in the United States: national, state, and regional trends, 2000\u20132013, Surveillance Report #105. Liver cirrhosis mortality in the United States: national, state, and regional trends, 2000\u20132013, 2016, National Institute on Alcohol Abuse and Alcoholism (NIAAA); Bethesda (MD), Available at: http:\/\/pubs.niaaa.nih.gov\/publications\/Surveillanc e105\/Cirr13.pd, Accessed February 2023."},{"key":"10.1016\/j.pop.2023.03.007_bib9","unstructured":"Centers for Disease Control and Prevention. 2019 Viral Hepatitis Surveillance Report. Available at: https:\/\/www.cdc.gov\/hepatitis\/statistics\/SurveillanceRpts.htm. Published July 2021. Accessed October 2022."},{"key":"10.1016\/j.pop.2023.03.007_bib10","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1002\/hep.24804","article-title":"Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin","volume":"56","author":"Kowdley","year":"2012","journal-title":"Hepatology"},{"key":"10.1016\/j.pop.2023.03.007_bib11","unstructured":"Available at: https:\/\/www.cdc.gov\/hepatitis\/outbreaks\/2017March-HepatitisA.htm."},{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cld.2019.08.002","article-title":"Epidemiology, predisposing factors, and outcomes of drug-induced liver injury","volume":"24","author":"Bj\u00f6rnsson","year":"2020","journal-title":"Clin Liver Dis"},{"key":"10.1016\/j.pop.2023.03.007_bib13","unstructured":"Moriles KE, Azer SA. Alanine amino transferase. [Updated 2022 Dec 10]. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559278\/."},{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/ajg.2016.517","article-title":"ACG clinical guideline: evaluation of abnormal liver chemistries","volume":"112","author":"Kwo","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"10.1016\/j.pop.2023.03.007_bib15","series-title":"Clinical methods: the history, physical, and laboratory examinations","first-page":"494","article-title":"Alkaline phosphatase and gamma glutamyltransferase","author":"Vroon","year":"1990"},{"key":"10.1016\/j.pop.2023.03.007_bib16","unstructured":"Lowe D. Sanvictores T. John S. Alkaline Phosphatase. Updated 2022 Aug 8. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459201\/."},{"key":"10.1016\/j.pop.2023.03.007_bib17","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/gutjnl-2017-314924","article-title":"Guidelines on the management of abnormal liver blood tests","volume":"67","author":"Newsome","year":"2018","journal-title":"Gut"},{"key":"10.1016\/j.pop.2023.03.007_bib18","unstructured":"Lala V. Goyal A. Minter DA. Liver Function Tests. Updated 2022 Mar 19. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482489\/."},{"key":"10.1016\/j.pop.2023.03.007_bib19","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1572-0241.2005.00341.x","article-title":"The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999\u20132002","volume":"101","author":"Ioannou","year":"2006","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"10.1016\/j.pop.2023.03.007_bib20","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.jhep.2016.09.022","article-title":"\u201cBi-directional analysis between fatty liver and cardiovascular disease risk factors.\u201d","volume":"66","author":"Ma","year":"2017","journal-title":"J Hepatol"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib21","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/0016-5085(94)90235-6","article-title":"\u201cNonalcoholic steatohepatitis: an expanded clinical entity.\u201d","volume":"107","author":"Bacon","year":"1994","journal-title":"Gastroenterology"},{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib22","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/hep.21902","article-title":"Acute hepatitis C virus infection: a chronic problem","volume":"47","author":"Blackard","year":"2008","journal-title":"Hepatology"},{"key":"10.1016\/j.pop.2023.03.007_bib23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0168-8278(99)80368-7","article-title":"\u201cHepatitis C: the clinical spectrum of the disease.\u201d","volume":"31","author":"Marcellin","year":"1999","journal-title":"J\u00a0Hepatol"},{"issue":"2","key":"10.1016\/j.pop.2023.03.007_bib24","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1067\/mjd.2001.109311","article-title":"Hepatitis C: a review and update","volume":"44","author":"Bonkovsky","year":"2001","journal-title":"J\u00a0Am Acad Dermatol"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib25","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jpainsymman.2005.08.016","article-title":"Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection","volume":"31","author":"Lang","year":"2006","journal-title":"J\u00a0Pain Symptom Manage"},{"key":"10.1016\/j.pop.2023.03.007_bib26","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1002\/hep.22375","article-title":"Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression","volume":"48","author":"Thein","year":"2008","journal-title":"Hepatology"},{"issue":"2","key":"10.1016\/j.pop.2023.03.007_bib27","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.gtc.2020.01.002","article-title":"Epidemiology, natural history, unusual clinical manifestations, and prevention","volume":"49","author":"Abutaleb","year":"2020","journal-title":"Gastroenterol Clin North Am"},{"issue":"171 Suppl","key":"10.1016\/j.pop.2023.03.007_bib28","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1093\/infdis\/171.Supplement_1.S15","article-title":"Clinical manifestations of hepatitis a: recent experience in a community teaching hospital","volume":"1","author":"Tong","year":"1995","journal-title":"J\u00a0Infect Dis"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib29","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.3892\/etm.2016.3627","article-title":"Clinical characteristics of drug-induced liver injury and related risk factors","volume":"12","author":"Lu","year":"2016","journal-title":"Exp Ther Med"},{"issue":"5","key":"10.1016\/j.pop.2023.03.007_bib30","doi-asserted-by":"crossref","first-page":"878","DOI":"10.14309\/ajg.0000000000001259","article-title":"Practice parameters committee of the american college of gastroenterology. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury","volume":"116","author":"Chalasani","year":"2021","journal-title":"Am J Gastroenterol"},{"issue":"no. 8","key":"10.1016\/j.pop.2023.03.007_bib31","article-title":"\u201cPrevalence and profile of non-alcoholic fatty liver disease among adults undergoing master health checkup, a Hospital Based Cross Sectional Study.\u201d","volume":"6","author":"Sangeetha","year":"2019","journal-title":"International Journal of Contemporary Medical Research"},{"issue":"1","key":"10.1016\/j.pop.2023.03.007_bib32","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the american association for the study of liver diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"issue":"887","key":"10.1016\/j.pop.2023.03.007_bib33","first-page":"145","article-title":"A\u00a0combination of raised serum AST: ALT ratio and erythrocyte mean cell volume level detects excessive alcohol consumption","volume":"103","author":"Kawachi","year":"1990","journal-title":"N\u00a0Z Med J"},{"issue":"6","key":"10.1016\/j.pop.2023.03.007_bib34","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1002\/hep.25762","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the american association for the study of liver diseases, american college of gastroenterology, and the american gastroenterological association","volume":"55","author":"Chalasani","year":"2012","journal-title":"Hepatology"},{"key":"10.1016\/j.pop.2023.03.007_bib35","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption\u2014II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"issue":"3","key":"10.1016\/j.pop.2023.03.007_bib36","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1503\/cmaj.1040752","article-title":"Liver enzyme alteration: a guide for clinicians","volume":"172","author":"Giannini","year":"2005","journal-title":"CMAJ (Can Med Assoc J)"},{"issue":"3","key":"10.1016\/j.pop.2023.03.007_bib37","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1002\/hep.23190","article-title":"Chronic hepatitis B: update 2009","volume":"50","author":"Lok","year":"2009","journal-title":"Hepatology"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib38","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance","volume":"67","author":"Terrault","year":"2018","journal-title":"Hepatology"},{"issue":"2","key":"10.1016\/j.pop.2023.03.007_bib39","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1002\/hep.31060","article-title":"AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019\u00a0Update: american association for the study of liver diseases-infectious diseases society of america recommendations for testing, managing, and treating Hepatitis C virus infection","volume":"71","author":"Ghany","year":"2020","journal-title":"Hepatology"},{"key":"10.1016\/j.pop.2023.03.007_bib40","series-title":"LiverTox: clinical and research information on drug-induced liver injury","year":"2012"},{"issue":"7","key":"10.1016\/j.pop.2023.03.007_bib41","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1053\/j.gastro.2015.03.006","article-title":"United States drug induced liver injury network. features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study","volume":"148","author":"Chalasani","year":"2015","journal-title":"Gastroenterology"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib42","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s00125-011-2446-4","article-title":"\u201cImpact of Current Treatments on Liver Disease, Glucose Metabolism and Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease (NAFLD): a systematic review and meta-analysis of randomised trials.\u201d","volume":"55","author":"Musso","year":"2012","journal-title":"Diabetologia"},{"issue":"6","key":"10.1016\/j.pop.2023.03.007_bib43","doi-asserted-by":"crossref","DOI":"10.1016\/j.cgh.2018.10.017","article-title":"\u201cComplete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis.\u201d","volume":"17","author":"Lee","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"3","key":"10.1016\/j.pop.2023.03.007_bib44","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/00365520802555991","article-title":"Alcohol consumption is associated with progression of hepatic fibrosis in non-alcoholic fatty liver disease","volume":"44","author":"Ekstedt","year":"2009","journal-title":"Scand J Gastroenterol"},{"issue":"4","key":"10.1016\/j.pop.2023.03.007_bib45","first-page":"CD001511","article-title":"Glucocorticosteroids for people with alcoholic hepatitis","author":"Pavlov","year":"2019","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Primary Care: Clinics in Office Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0095454323000246?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0095454323000246?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T15:54:04Z","timestamp":1758815644000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0095454323000246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["S0095454323000246"],"URL":"https:\/\/doi.org\/10.1016\/j.pop.2023.03.007","relation":{},"ISSN":["0095-4543"],"issn-type":[{"value":"0095-4543","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Approach to Elevated Liver Enzymes","name":"articletitle","label":"Article Title"},{"value":"Primary Care: Clinics in Office Practice","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pop.2023.03.007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2023 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}