{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:07:03Z","timestamp":1777547223885,"version":"3.51.4"},"reference-count":23,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012350","name":"British Liver Trust","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012350","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Southampton Biomedical Research Centre"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,1,6]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Most patients are unaware they have liver cirrhosis until they present with a decompensating event. We therefore aimed to develop and validate an algorithm to predict advanced liver disease (AdvLD) using data widely available in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>Logistic regression was performed on routinely collected blood result data from the University Hospital Southampton (UHS) information systems for 16\u2009967 individuals who underwent an upper gastrointestinal endoscopy (2005\u20132016). Data were used to create a model aimed at detecting AdvLD: \u2018CIRRhosis Using Standard tests\u2019 (CIRRUS). Prediction of a first serious liver event (SLE) was then validated in two cohorts of 394\u2009253 (UHS: primary and secondary care) and 183\u2009045 individuals (Care and Health Information Exchange (CHIE): primary care).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Model creation dataset: cirrhosis or portal hypertension. Validation datasets: SLE (gastro-oesophageal varices, liver-related ascites or cirrhosis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the model creation dataset, 931 SLEs were recorded (5.5%). CIRRUS detected cirrhosis or portal hypertension with an area under the curve (AUC) of 0.90 (95% CI 0.88 to 0.92). Overall, 3044 (0.8%) and 1170 (0.6%) SLEs were recorded in the UHS and CHIE validation cohorts, respectively. In the UHS cohort, CIRRUS predicted a first SLE within 5\u2009years with an AUC of 0.90 (0.89 to 0.91) continuous, 0.88 (0.87 to 0.89) categorised (crimson, red, amber, green grades); and AUC 0.84 (0.82 to 0.86) and 0.83 (0.81 to 0.85) for the CHIE cohort. In patients with a specified liver risk factor (alcohol, diabetes, viral hepatitis), a crimson\/red cut-off predicted a first SLE with a sensitivity of 72%\/59%, specificity 87%\/93%, positive predictive value 26%\/18% and negative predictive value 98%\/99% for the UHS\/CHIE validation cohorts, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Identification of individuals at risk of AdvLD within primary care using routinely available data may provide an opportunity for earlier intervention and prevention of liver-related morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044952","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T20:30:35Z","timestamp":1613075435000},"page":"e044952","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Can routine blood tests be modelled to detect advanced liver disease in the community: model derivation and validation using UK primary and secondary care data"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7768-6886","authenticated-orcid":false,"given":"Theresa","family":"Hydes","sequence":"first","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5127-4509","authenticated-orcid":false,"given":"Michael","family":"Moore","sequence":"additional","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Stuart","sequence":"additional","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda","family":"Kim","sequence":"additional","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangzhong","family":"Su","sequence":"additional","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Newell","sequence":"additional","affiliation":[{"name":"Human Development and Health, University of Southampton Faculty of Medicine, Southampton, Southampton, UK"},{"name":"Southampton Biomedical Research Centre, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Cable","sequence":"additional","affiliation":[{"name":"Informatics, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Hales","sequence":"additional","affiliation":[{"name":"School of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire, UK"},{"name":"AH IT Solutions, Southampton, Hampshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Sheron","sequence":"additional","affiliation":[{"name":"The Institute of Hepatology, Foundation for Liver Research, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"2025120519523256000_11.2.e044952.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"2025120519523256000_11.2.e044952.2","unstructured":"National Institute for Health and Care Excellence . Cirrhosis in over 16S: assessment and management NG50, 2016."},{"key":"2025120519523256000_11.2.e044952.3","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S2468-1253(16)30205-9","article-title":"Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review","volume":"2","author":"Harris","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120519523256000_11.2.e044952.4","unstructured":"ISRCTN R . LOCATE - LOcal Care And Treatment Evaluation, 2018."},{"key":"2025120519523256000_11.2.e044952.5","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp12X654588"},{"key":"2025120519523256000_11.2.e044952.6","doi-asserted-by":"crossref","unstructured":"Collett D . Modelling binary data. 2nd edn. Chapman and Hall, 1991: 93.","DOI":"10.1007\/978-1-4899-4475-7"},{"key":"2025120519523256000_11.2.e044952.7","unstructured":"Exchange CaI . 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