UNSCHEDULED care attendances provide an opportunity to identify patients at high risk of advanced and decompensated liver disease (DLD), a 2026 retrospective cohort study has found.
A significant number of patients with high unscheduled care (Emergency Department and GP referrals to acute admissions) attendance rates and no known liver diagnosis went on to be admitted to hospital with liver disease in a five-year follow-up.
Liver Disease Detection and Unscheduled Care Attendance
Liver cirrhosis is one of the leading causes of mortality and morbidity in the working age population. Amid improvements in the remainder of Western Europe, mortality in the UK has continued to rise over the past decade.
One fifth of patients presenting to hospital with decompensated liver disease (DLD) have no prior diagnosis and approximately 15% of them will not survive their first hospitalisation.
Around half of patients with alcohol-related cirrhosis are diagnosed during hospital admission rather than in primary or community care. UK patients admitted with alcohol-related liver disease have an average of five previous unscheduled care attendances.
Unscheduled Care and Future Hospital Admission
Patients attending unscheduled care between the start of 2018 and end of 2020 were examined, with clinical follow-up until the end of 2022. Nearly 173,500 patients were included in analysis.
More than 1,600 patients had a DLD-related admission in the 5-year follow-up period. This cohort of patients experienced multiple missed opportunities for diagnosis and intervention.
Researchers designed a model to predict future admission based on the Fibrosis 4 (FIB-4) index, geographical deprivation decile, and assigned sex. It had a Harrell’s C statistic of 0.78.
The Excluded Cohort
Blood tests for FIB-4 were often unavailable, leading to the exclusion of a substantial number of the cohort. When those excluded due to missing blood tests were analysed, they had similar distributions of sex and deprivation but a mean age of nearly 12 years younger.
The excluded cohort had had a lower proportion of subsequent DLD: 0.6% compared with 0.9%. suggesting that focusing on patients who have had their bloods taken selects a group at higher baseline risk.
Findings are only applicable to patients who have had the appropriate blood tests as part of their unscheduled admission.
Implications for DLD Assessment
Researchers established the value of unscheduled care presentations in identifying those at high risk of advanced liver disease and DLD.
It was suggested that a model using simple laboratory and demographic data might aid DLD detection for patients at risk of liver-related admission.
References
Swann R et al. Identifying patients at high risk of decompensated liver disease through unscheduled care attendance data: a retrospective cohort study. BMC Gastroenterol. 2026;DOI:10.1186/s12876-025-04534-2.
Subhani M et al. Alcohol-related liver disease mortality and missed opportunities in secondary care: A United Kingdom retrospective observational study. Drug Alcohol Rev. 2022;41(6):1331-1340.
