The clinical importance of routine measurement of liver enzymes, total protein and albumin in a general medicine outpatient clinic: a prospective study.
The objective was to study the usefulness of routine measurement of liver enzymes (ASAT, ALAT, alkaline phosphatase, gamma-GT), and total protein (TP) and albumin (Alb) in a general medicine outpatient clinic. A prospective study was made of consecutive patients who were classified according to whether or not an indication for the tests was present. All six tests were measured in all patients. Physicians were kept unaware of the results of tests in patients with no indication for ordering the test. The setting was a general internal medicine outpatient clinic in a 850-bed teaching hospital which serves as a referral clinic for general practitioners. There were 615 consecutive patients who were all new referrals to the outpatient clinic. The results of all patients with no indication for the test but who had abnormal results were presented to a panel of three experienced internists who decided whether the results had any clinical importance. Repeat measurements of the tests or follow-up results were obtained in all these patients. Seventy-eight of 320 patients in whom no indication for the test for liver enzymes existed had abnormal results. In only six of these (1.9%) were the abnormalities of clinical significance. In 56 of 449 patients in whom no indications were present for TP and Alb measurement the results were abnormal. In only 2 (0.4%) was this clinically important.


CONCLUSIONS
the routine measurement of these six tests in general medicine outpatient clinics should be abandoned because of the low yield.
Veldhuyzen van Zanten
S J
SJ
Department of Internal Medicine, Academic Medical Centre, Amsterdam, Netherlands.
Depla
A C
AC
Dekker
P C
PC
Langius
F A
FA
Wesche
M F
MF
Sanders
G T
GT
Wieling
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000032:analysis*; D002648:Child; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010044:Outpatient Clinics, Hospital; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis*
D001798:Blood Proteins; D012709:Serum Albumin