Management of asymptomatic patients with abnormal liver function tests

• Published in: European journal of internal medicine p. 106429
• Main Authors: Gabeta, Stella, Dalekos, George N., Gatselis, Nikolaos K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 09.08.2025
• Subjects: Abnormal liver enzymes; Alkaline phosphatase; Aminotransferases; Asymptomatic; Gamma-glutamyl transferase; Liver function tests; AUDIT; Alkaline phosphatase; NAFLD; Gamma-glutamyl transferase; ALP; Abnormal liver enzymes; IgG; ALT; Asymptomatic; SLD; MASH; IBD; anti-HBe; PBC; AMA; MetALD; HBV; anti-HCV; AIH; PSC; AST; DILI; HBeAg; AI; HBsAg; MASLD; γGT; anti-HBc; Aminotransferases; ANA; MRCP; ICP; ALD; LFTs; CLD; HCV; Liver function tests
• ISSN: 0953-6205; 1879-0828; 1879-0828
• DOI: 10.1016/j.ejim.2025.07.025

•Abnormal LFTs are often overlooked, leading to delays in diagnosis.•Identification of LFTs pattern into hepatocellular or cholestatic, based on the R-ratio, is of paramount importance for guiding further diagnostic evaluation.•MASLD is the most common global cause of chronic liver disease (CLD).•Chronic viral hepatitis B or C, alcohol-related liver disease and DILI are other common important contributors to CLD and must be evaluated thoroughly.•In asymptomatic subjects with profound cholestatic pattern thorough evaluation for underline PBC, PSC or DILI should be performed. Liver function tests are routinely included in screening blood tests, resulting in frequent detection of deranged values, even in asymptomatic individuals. In view of the silent course of many liver diseases until the onset of complications and the diagnostic delays asymptomatic patients may experience, identification of those at risk for chronic liver disease remains a challenge. Underestimation of abnormal liver biochemistry may increase morbidity and mortality, while overestimation potentially leads to unnecessary diagnostic testing and medical interventions. Herein, we aim to provide an effective clinical approach for internists and general practitioners, that could be used in routine clinical practice to promptly establish a definite diagnosis. Key components include a detailed medical and medication history, a meticulous physical examination, and relevant laboratory and imaging studies. Recognition of the principal abnormality, namely hepatocellular injury or cholestasis, followed by algorithms can ensure early diagnosis and prompt referral to specialists, facilitating appropriate intervention and improved outcomes.