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Long-term follow-up of patients with ultra-sound detected 'fatty liver' in primary care

Leads: Mr James Ferguson (Long-term Conditions), Prof Richard Lilford, Ms Felicity Evison, Dr Katharine Reeves (Meths)

A group of public contributors with experience of liver conditions and having liver function tests are working alongside the team in this study.

Dates: March 2020 - ongoing


The Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS) study was a five-year study carried out in Birmingham and Lambeth. Its aim was to evaluate mildly abnormal liver function test (LFT) results in general practice among patients who did not have known liver disease. Results were published in 2013: [Lilford RJ, et al. Health Technol Assess. 2013;17(28):i-307]. We now have the opportunity to follow-up the patients that took part in this study to gain an improved understanding of longer-term health outcomes.

Policy and Practice Partners:

Thirteen primary care practices in Birmingham and London.

Co-Funding Partners:

University Hospitals Birmingham NHS Foundation Trust.

Aims and Objectives:

Over one-third of people in the original BALLETS study had a fatty liver on their scan. We now have the opportunity to follow-up the same 1,290 patients that took part in the original BALLETS study. This additional research will give us an even better understanding of longer-term health outcomes for people who have a mildly abnormal LFT. The original BALLETS study followed-up patients two years after they had a mildly abnormal LFT to see if they developed liver-related health problems. We will be able to see if the same people developed liver-related problems after a period of 15 years. We want to compare the outcomes in people who did or did not have fatty livers in order to guide future care.


In this study, we will be electronically linking patients' NHS numbers with two national databases to find out if they developed any liver-related health problems during the period 2007-2020. The two datasets we will be using are: Hospital Episode Statistics (this dataset will allow us to identify patients with inpatient admissions or outpatient attendances for liver disease) and Office of National Statistics (this dataset will allow us to identify all patients who have died since taking part in the original BALLETS study).





Implications for Implementation:

If the low specificity of ultrasound-detected fatty liver is confirmed, then it will provide strong evidence against current demand for routine screening and/or referral of patients. It will be of direct interest to the public and provide evidence to reduce over-medicalisation of society. It will also massively reduce waste, and is likely to influence NICE and other guideline development organisations worldwide. On the other hand, if it turns out that primary care detected fatty liver is indeed a strong risk factor for subsequent cirrhosis, then screening and referral may be justified.