Validation of the liver traffic light test as a predictive model for survival and development of liver-related events

Rochelle Sylvester, Theresa J. Hydes, Alan Hales, Roger Williams, Nick Sheron*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and Aim: Liver disease mortality rates continue to rise due to late diagnosis. We need noninvasive tests to be made available in the community that can identify patients at risk from a serious liver-related event (SLE). We examine the performance of a blood test, the liver traffic light test (LTLT), with regard to its ability to predict survival and SLEs. Methods: Using routinely gathered clinical data, sequential LTLT test results from 4854 individuals with suspected liver disease were prospectively analyzed (median follow-up 41 months). An SLE was defined as the development of cirrhosis, liver failure, ascites, or varices. Patients were graded as follows: red (high risk), amber (intermediate risk), and green (low risk). Results: Overall, 565 individuals experienced an SLE (11.6%). The area under the curve (AUC) for the continuous LTLT variable was 0.87 (95% confidence interval 0.85–0.89) for prediction of an SLE and 0.81 (0.78–0.84) for mortality. When categorized into red/amber/green grades, a red LTLT result predicted an SLE with negative and positive predictive values of 0.97 and 0.29, respectively. A red LTLT score predicted mortality with negative and positive predictive values of 0.98 and 0.18, respectively. Kaplan–Meier plots demonstrated increased mortality and SLEs in the red group versus the green and amber groups (P < 0.001) and an increase in SLEs in the amber versus green group (P < 0.001). Conclusion: Here, the LTLT is further validated for the prediction of survival and SLE development. The LTLT could aid primary care risk management and referral pathways with the aim of detecting and treating liver disease earlier in the general population.

Original languageEnglish
Pages (from-to)549-557
Number of pages9
JournalJGH Open
Issue number5
Publication statusPublished - May 2021
Externally publishedYes

Bibliographical note

Funding Information:
We thank David Cable for helpful assistance with UHS information systems over many years and Corrine Hughes for assistance with manuscript editing. We also thank Professor Roger Williams CBE, the seminal figure of UK Hepatology, who helped edit the manuscript but sadly passed away before publication. This work was supported by the Institute of Hepatology, Foundation for Liver Research and Public Health England. The views expressed here may not reflect the stated position or policy of the Department of Health and Social Care.

Publisher Copyright:
© 2020 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.


  • alcoholic liver disease
  • ascites
  • fatty liver
  • liver fibrogenesis


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