Summary of published community pathways for detection of liver disease in the UK
| Pathway | LFT or risk factor | Input from Primary Care | Next steps | Outcome |
| Camden and Islington NAFLD Pathway25 | LFT | Calculate FIB-4 after clinically diagnosing NAFLD (based on elevated ALT, non-harmful alcohol use±steatosis on US) | If FIB-4 elevated, patient referred to secondary care; if FIB-4 indeterminate, GP then performs ELF | If ELF elevated, refer to secondary care |
| Gateshead Project28 | Risk factor | FIB-4 calculated at routine diabetic clinic | If FIB-4 elevated, GP refers for TE | Patients with abnormal TE referred to secondary care |
| Gwent AST Project24 | LFT | Request LFTs | Automated reflex AST with AST:ALT ratio calculation | If AST:ALT ratio≥1, direct access to TE provided |
| Intelligent liver function testing (iLFT)23 | LFT | Request LFTs and provide BMI, alcohol intake and comorbidities at time of request | Automated reflex testing of full aetiological liver screen with non-invasive fibrosis scores and ELF where indicated | 32 individual outcomes detailing likely aetiology, stage of fibrosis and management plan including if/when to refer to secondary care |
| Leeds Community Hepatology Pathway (CHEP)29 | LFT and risk factor (‘GP suspicion’) | Perform ELF in patients with suspected CLD | If ELF elevated, GP refers for community TE | If TE elevated, specialist review |
| Scarred Liver Project26 | Risk factor | Complete algorithm for patients at risk | If meet criteria, patient referred directly for TE | All patients provided with liver health information from British Liver Trust; patients with abnormal TE referred to secondary care |
ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CLD, chronic liver disease; ELF, enhanced liver fibrosis; FIB-4, Fibrosis-4; LFT, liver function test; NAFLD, non-alcoholic (metabolic) fatty liver disease; TE, transient elastography.