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Finding people with chronic liver disease and silent liver cirrhosis (scarring) who are at risk of liver failure and liver cancer is a critical public health issue.

The AST-to-platelet ratio index (APRI) and FIB-4 index estimate the risk of liver cirrhosis using routine blood tests.

In this study, we determine whether an innovative community-level cirrhosis screening program of automated APRI and FIB-4 calculation on routine pathology blood test results increases liver cirrhosis diagnosis and linkage to specialist care.

  1. To describe the proportion of APRI > 1.0 and FIB-4 scores > 2.67 among people who undergo routine liver function and full blood count testing through St Vincent’s Pathology service
  2. To describe the socio-demographic distribution of people with elevated APRI and FIB-4 scores
  3. To determine the number of Fibroscan referrals per month after the introduction of automated APRI and FIB-4 calculations on St Vincent’s pathology reports compared to prior to the intervention
  4. To determine the number and proportion of people referred for a Fibroscan following an automated APRI score of > 1.0 and/ or FIB-4 score > 2.67 who attend their Fibroscan appointment within the study period
  5. To determine the accuracy of APRI and FIB-4 for cirrhosis diagnosis among those who undergo Fibroscan at St Vincent’s Hospital.


Single arm health systems intervention study.

Liver cirrhosis and liver cancer have high mortality rates. 

Early detection of people with clinically silent liver cirrhosis and linkage to specialist care enables timely treatments to prevent deaths from complications of cirrhosis. It will also facilitate early enrolment into liver cancer surveillance programs to ensure liver cancer is diagnosed early, when still amenable curable treatments.

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Associate Professor Jessica Howell

Contact Associate Professor Jessica Howell for more information about this project. 



  • St Vincent’s Pathology
  • Gilead Sciences (Gilead Australia Fellowship Dr Ericka Flores)
  • St Vincent’s Foundation REF grant

Partners +

  • St Vincent’s Hospital
  • St Vincent’s Pathology
  • University of Melbourne


Meet the project team. Together, we are translating research into better health, for all.