Optimum Sequence of Liver Serology in an Inpatient Setting

Leonid Shamban D.O., Graham Appelbe D.O., Matthew Chadwick D.O, Rita Rehana M.D., Kimberly Barber Ph.D., Justin Miller D.O., F.A.C.O.I.

Abstract


Aims: To investigate the most cost effective and highest diagnostic yield of sequential vs. ‘shotgun’ approach when evaluating the cause of elevated liver biochemistries in the inpatient setting as it relates to Wilson’s Disease (WD) and Alpha-1 Antitrypsin Disease (AATD).

Materials and Methods: Inpatients without chronic liver disease were evaluated for acute elevated liver biochemistries and stratified into two cohorts: sequential and ‘shotgun’. Sequential had only an acute viral hepatitis panel ordered initially while ‘shotgun’ included the viral hepatitis panel and ceruloplasmin and/or alpha-1 antitrypsin level/phenotype.  Diagnostic yield, length of stay, hospital acquired infections, and overall cost were evaluated.  Secondary analysis evaluated how often each approach was used by different types of providers and hospital setting.

Results: 738 patients were evaluated, 23% using the ‘shotgun’ approach. Neither approach diagnosed WD or AATD.  Patients in the sequential approach were discharged 1.06 days later (p=0.052), contributing to $2337 more per patient. There was no difference in the number of hospital acquired infections between approaches (p=0.36).

Conclusion: In the inpatient setting the yield of screening for WD or AATD in patients presenting with elevated liver biochemistries is low, however if these tests are ordered, it is more cost effective to use a ‘shotgun’ approach.

Keywords: Alpha 1 Antitrypsin; Ceruloplasmin; Wilson's Disease; Liver Biochemistries; Viral Hepatitis

 


Keywords


Alpha 1 Antitrypsin; Ceruloplasmin; Wilson's Disease; Liver Biochemistries; Viral Hepatitis

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