{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T01:53:14Z","timestamp":1768009994302,"version":"3.49.0"},"reference-count":39,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,5,13]]},"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To derive and validate a clinical prediction model to estimate the risk of liver disease diagnosis following liver function tests (LFTs) and to convert the model to a simplified scoring tool for use in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based observational cohort study of patients in Tayside Scotland identified as having their LFTs performed in primary care and followed for 2\u2005years. Biochemistry data were linked to secondary care, prescriptions and mortality data to ascertain baseline characteristics of the derivation cohort. A separate validation cohort was obtained from 19 general practices across the rest of Scotland to externally validate the final model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Primary care, Tayside, Scotland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Derivation cohort: LFT results from 310\u2005511 patients. After exclusions (including: patients under 16\u2005years, patients having initial LFTs measured in secondary care, bilirubin &gt;35\u2005\u03bcmol\/L, liver complications within 6\u2005weeks and history of a liver condition), the derivation cohort contained 95\u2005977 patients with no clinically apparent liver condition. Validation cohort: after exclusions, this cohort contained 11\u2005653 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Diagnosis of a liver condition within 2\u2005years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From the derivation cohort (n=95\u2005977), 481 (0.5%) were diagnosed with a liver disease. The model showed good discrimination (C-statistic=0.78). Given the low prevalence of liver disease, the negative predictive values were high. Positive predictive values were low but rose to 20\u201330% for high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study successfully developed and validated a clinical prediction model and subsequent scoring tool, the Algorithm for Liver Function Investigations (ALFI), which can predict liver disease risk in patients with no clinically obvious liver disease who had their initial LFTs taken in primary care. ALFI can help general practitioners focus referral on a small subset of patients with higher predicted risk while continuing to address modifiable liver disease risk factors in those at lower risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-004837","type":"journal-article","created":{"date-parts":[[2014,6,2]],"date-time":"2014-06-02T23:52:52Z","timestamp":1401753172000},"page":"e004837","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Prediction of liver disease in patients whose liver function tests have been checked in primary care: model development and validation using population-based observational cohorts"],"prefix":"10.1136","volume":"4","author":[{"given":"David J","family":"McLernon","sequence":"first","affiliation":[{"name":"Medical Statistics Team, Division of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter T","family":"Donnan","sequence":"additional","affiliation":[{"name":"Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank M","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Roderick","sequence":"additional","affiliation":[{"name":"Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William M","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Centre for Hepatology, Division of Medicine and ULCH-UCL NIHR Biomedical Research Centre, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve D","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nottingham University Hospitals NHS Trust and Biomedical Research Unit, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F","family":"Dillon","sequence":"additional","affiliation":[{"name":"Medical Research Institute, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,6,2]]},"reference":[{"key":"2025121512431635000_4.6.e004837.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004273421707"},{"key":"2025121512431635000_4.6.e004837.2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwj312"},{"key":"2025121512431635000_4.6.e004837.3","first-page":"420","article-title":"Epidemiology of abnormal liver function tests in general practice in a defined population in Denmark","volume":"38","author":"Sorensen","year":"1991","journal-title":"Dan Med Bull"},{"key":"2025121512431635000_4.6.e004837.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38050.593634.63"},{"key":"2025121512431635000_4.6.e004837.5","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1136\/bmj.328.7446.987","article-title":"Commentary: liver function tests: defining what's normal","volume":"328","author":"Roderick","year":"2004","journal-title":"BMJ"},{"key":"2025121512431635000_4.6.e004837.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7281.276"},{"key":"2025121512431635000_4.6.e004837.7","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmp025"},{"key":"2025121512431635000_4.6.e004837.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b375"},{"key":"2025121512431635000_4.6.e004837.9","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmi092"},{"key":"2025121512431635000_4.6.e004837.10","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2010.01.2102"},{"key":"2025121512431635000_4.6.e004837.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b605"},{"key":"2025121512431635000_4.6.e004837.12","doi-asserted-by":"crossref","first-page":"iii","DOI":"10.3310\/hta13250","article-title":"Development of a decision support tool for primary care management of patients with abnormal liver function tests without clinically apparent liver disease: a record-linkage population cohort study and decision analysis (ALFIE)","volume":"13","author":"Donnan","year":"2009","journal-title":"Health Technol Assess"},{"key":"2025121512431635000_4.6.e004837.13","first-page":"210","article-title":"Deprivation and mortality: an alternative to social class?","volume":"11","author":"Carstairs","year":"1989","journal-title":"Community Med"},{"key":"2025121512431635000_4.6.e004837.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.1999.00853.x"},{"key":"2025121512431635000_4.6.e004837.15","unstructured":"NHS National Services Scotland. 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