Physicians over-relying on a commonly used laboratory test can miss liver cirrhosis

A recent study at the Medical University of South Carolina’s (MUSC) Digestive Disease Research Core Center (DDRCC) provides insight into why physicians should be cautious when using a certain liver function test to diagnose alcoholic cirrhosis.

Alcoholic cirrhosis affects around 1 in 400 adults in the U.S. It is an advanced form of liver disease, which occurs when chronic ethanol use leads to inflammation and cirrhosis or scarring of the liver. Less than 50% of people diagnosed with advanced liver disease due to cirrhosis survive for one year, and so early diagnosis is crucial. Although cirrhosis is generally not a reversible condition, early diagnosis provides physicians with an opportunity to encourage cessation of drinking and offer treatment that can reduce symptoms and increase life expectancy. 

A common method to diagnose patients with alcoholic cirrhosis is to look for elevated levels of enzymes known as  aminotransferases in the liver. However, the MUSC study, published in The American Journal of Medical  Sciences, found that patients with alcoholic cirrhosis have nearly normal levels of aminotransferases. In this study, liver function test results of 78 patients with alcoholic cirrhosis revealed that 90% had normal test results for alanine aminotransferase and 15% for aspartate aminotransferase. 

The study’s findings are important because physicians who rely only on these tests can fail to diagnose alcoholic cirrhosis, said MUSC Health gastroenterologist and DDRCC director Don Rockey, M.D., who led the study. 

In his own practice, Rockey has often observed that his patients with advanced liver disease have normal results on this test. 

“We would see these patients with advanced disease and complications, yet their liver tests seemed to be normal. So, if you just looked at their liver tests, you’d say, ‘Oh no problem,’ but in fact, that wasn’t the case,” said Rockey.  

Often, patients may show subtle signs and symptoms in the early stages of alcoholic cirrhosis. However, if physicians look only at the laboratory results and not the patient, they are going to be “faked out,” said Rockey.

“Doctors need to be paying attention to the history, the physical examination, the whole clinical picture,” he said.  

Physicians should also be aware of tools that are available to diagnose cirrhosis, said Rockey. Noninvasive diagnostic tools include cross-sectional imaging, CT scans, MRI scans and especially the new technique – elastography. Rockey explained that elastography is a simple, noninvasive and convenient way to assess fibrosis and scarring in the liver. This test, available at MUSC and other tertiary care centers, can be performed easily in clinics or at the patient’s bedside.

Rockey said that the next step is to educate as many providers as possible and spread the word. While physicians who specialize in gastroenterology may understand that these laboratory tests are not always reliable, it is important to get this information out to a wide variety of practitioners.

“The core message here is that if you just look at the test, you’ll miss the diagnosis,” he said.

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About MUSC

Founded in 1824 in Charleston, the Medical University of South Carolina (MUSC) is the oldest medical school in the South as well as the state's only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and nearly 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state's leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit musc.edu.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians' practice plan and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2020, for the sixth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.

MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.