A prospective study of the causes of notably raised aspartate aminotransferase of liver origin

Abstract

Background and aims-To ascertain the causes of raised aspartate aminotransferase (AST) presumed to be of hepatic origin in two hospitals and the local community served by a centralised biochemistry laboratory. Methods-From June 1996 to February 1997 all patients with AST greater than 400 U/l were identified by the biochemistry laboratory; the patients' clinical records were studied to determine the diagnosis, the clinical outcome, and whether the raised AST and its significance had been noted. Results-A total of 137 patients with a hepatic cause for the raised AST were found. The cause of the raised AST was hepatic ischaemia/hypoxia in 68, pancreatobiliary disease in 33, primary hepatocellular disease in 23, hepatic malignancy in five, and hepatic haematoma in one. In seven patients the diagnosis was unclear. The overall mortality was high (22%) with the highest mortality in the hepatic ischaemia group (37%). The recording and interpretation of the causes of raised AST was poor with only 48% having the correct diagnosis. In 38% the raised AST was apparently not noticed by the attending clinicians. Conclusions-The commonest cause of a hepatitis like biochemical picture was hepatic hypoxia (50%) followed by pancreatobiliary disease (24%). Drug induced hepatic necrosis (8.8%) was uncommon and viral hepatitis was rare (3.6%). AST concentrations returned towards normal most rapidly in patients with hepatic hypoxia and calculous biliary obstruction. Hepatitis, viral or otherwise, is an uncommon cause of a typical hepatitic biochemical result in this community. (Gut 1999;45:129-133)

Hepatoprotective Effect of Ethanolic Extract of Lavandula officinalis L. in Alloxan-Induced Diabetic Rats

“…This protection mechanism provides resistance for the liver against alloxan-induced damage, through hepatic regeneration stimulation and liver lipid peroxidation inhibition (18). The increased plasma AST and ALT levels indicated that diabetes may induce hepatic dysfunction, as supported by previous findings of necrotic livers (19). Therefore, the increased transaminase activity in plasma may be mainly due to the leakage of these enzymes from the liver (20).…”

Liver enzyme alteration: a guide for clinicians

“…For example, about 60% of cases of elevated hepatic AST levels in Wales can be attributed to ischemic or toxic liver injury, 10 whereas orofecal transmittable hepatitis viruses are the major cause (> 60%) of sporadic acute and fulminant hepatitis in the Far East. 11 The incidence of primary biliary cirrhosis ranges from 1.9-2.2 per 100 000 in Australia to 0.34-0.42 per 100 000 in Asia, 12 and the prevalence of homozygosity for the C282Y mutation in the HFE gene can be found in about 5 per 1000 people of northern European descent 13 but 0.0001 per 100 people of African American ethnicity.…”

“…Ischemic and hypoxic acute liver damage is more likely in patients with concomitant clinical conditions such as sepsis or low-flow hemodynamic state. 10,28,30 Careful investigation of the patient's pharmacologic history is essential in order to identify medications and herbal products associated with hepatotoxicity. 16,17,35 Acetaminophen-induced hepatic damage causes 54% and 16% of the cases of acute liver failure in the United Kingdom and United States respectively.…”

Lotus Birth Associated With Idiopathic Neonatal Hepatitis

“…Acute pure cytolytic syndrome is characterized by severe increases in aspartate and alanine aminotransferases, with normal or moderately abnormal gamma-glutamyl transpeptidase. 5 Although microbiological data was uninformative, clinical and laboratory data suggest that the cytolysis was due to an infection.…”