The effect of using automated APRI calculation in pathology on diagnosis of liver cirrhosis and linkage to care: The Cirrhosis Automated APRI Screening Evaluation (CAPRISE) Study

The intervention will involve the automated calculation of: 1) Aspartate aminotransferase (AST) to platelet ratio index (APRI) = (AST level/ AST upper limit of normal)/platelet count)*100, where the AST upper limit of normal is lab and sex based, and 2) Fibrosis-4 (FIB-4) score calculation and reporting = (age*AST)/(platelet count*sqrt(ALT) Reporting of these values will be in a separate report of 'Fibrosis scores' that will be available if a Full Blood Count (FBC) and Liver tests (LFTs) have been performed. Recommendations based on repeated, elevated values will also be included on the report with APRI >1.0 and FIB-4>2.67 for consideration of referral for further investigation of chronic liver disease risk and specialist referral if age appropriate and not already known to the service provider. Primary care physicians utilising the recommendations will have the opportunity to discuss these results with individuals prior to referral and counselling about risk of liver disease that requires further work up prior to diagnosis.