Elevated Liver Enzymes: Emergency Department–Focused Management

Sulava, Eric; Bergin, Samuel W.; Long, Brit; Koyfman, Alexander

doi:10.1016/j.jemermed.2016.10.016

Cited by 6 publications

(5 citation statements)

References 58 publications

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“…Indirect (unconjugated) bilirubin is the waste product of heme metabolism, and it is taken up by the liver where it is converted to direct (conjugated) bilirubin and secreted into bile. Elevated direct bilirubin in association with increased ALP suggests bile flow obstruction [2]. Prothrombin time and serum albumin levels are the only true hepatic function tests within the regularly used LFT panel that demonstrate the liver's synthetic function [3].…”

Section: Liver Biochemical Testsmentioning

confidence: 99%

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department

et al. 2022

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Ultrasonography is often the initial modality used to evaluate patients found to have abnormal liver function tests (LFTs) in the emergency department. While an assessment for biliary ductal dilatation and obstruction remains one of the main questions to answer, radiologists should also be aware of the ultrasonographic appearance of other conditions that can cause abnormal LFTs. This may be crucial for the management and disposition of patients in the emergency department. This article reviews the ultrasonographic features of diseases that may cause abnormal LFTs.

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Section: Liver Biochemical Testsmentioning

confidence: 99%

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department

et al. 2022

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“…1a ), suggesting that p53 can affect global homeostasis. Interestingly, alterations in the serum concentrations and in the ratio of ALP, ALT, and AST commonly indicate liver malfunction 21 . These findings imply an important role of p53 in regulating liver normal homeostasis.…”

Section: Resultsmentioning

confidence: 99%

Various stress stimuli rewire the profile of liver secretome in a p53-dependent manner

et al. 2018

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Liver is an important secretory organ that consistently manages various insults in order to retain whole-body homeostasis. Importantly, it was suggested that the tumor-suppressor p53 plays a role in a variety of liver physiological processes and thus it is being regarded as a systemic homeostasis regulator. Using high-throughput mass spectrometric analysis, we identified various p53-dependent liver secretome profiles. This allowed a global view on the role of p53 in maintaining the harmony of liver and whole-body homeostasis. We found that p53 altered the liver secretome differently under various conditions. Under physiological conditions, p53 controls factors that are related mainly to lipid metabolism and injury response. Upon exposure to various types of cancer therapy agents, the hepatic p53 is activated and induces the secretion of proteins related to additional pathways, such as hemostasis, immune response, and cell adhesion. Interestingly, we identified a possible relationship between p53-dependent liver functions and lung tumors. The latter modify differently liver secretome profile toward the secretion of proteins mainly related to cell migration and immune response. The notion that p53 may rewire the liver secretome profile suggests a new non-cell autonomous role of p53 that affect different liver functions and whole organism homeostasis.

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“…Studies such as the Reducing Unnecessary Coagulation Testing in the Emergency Department (REDUCED) trial 22 have examined the effects of uncoupling coagulation tests in the ED and found that implementing systemic changes to the order panel resulted in fewer tests ordered without a negative effect on patient outcomes. However, a clinical review 23 of the management of elevated LFTs in the ED suggested that severely elevated LFTs suggest injury secondary to cardiorenal syndrome and should prompt physicians to evaluate for ADHF. Although we found that the diagnostic utility of abnormal LFTs was relatively low, a significant proportion of patients with suspected ADHF did not have LFTs ordered.…”

Section: Discussionmentioning

confidence: 99%

Use and diagnostic value of liver enzyme tests in the emergency department and subsequent heart failure diagnosis: a retrospective cohort study

et al. 2022

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ObjectivesTo determine (1) if liver function tests (LFTs) are ordered in the emergency department (ED) in patients with suspected acute decompensated heart failure (ADHF) and (2) if the pattern of LFT abnormalities are meaningfully associated with a discharge diagnosis of ADHF among patients for whom these tests were ordered.SettingWe conducted a single-centre retrospective cohort study of patients with suspected ADHF who were seen in an academic tertiary ED using electronic medical records.ParticipantsAll ED patients admitted with suspected ADHF from January 2017 to May 2018, defined as any patient who had a brain natriuretic peptide (BNP) ordered.Primary outcomeThe primary outcome was ADHF diagnosis at discharge.ResultsIn 5323 ED patients with suspected ADHF, 60% (n=3184) had LFTs ordered; 34.6% were abnormal. Men comprised 56% of patients with abnormal LFTs and the average age was 67 years. The odds of a final diagnosis of ADHF in the univariate analysis was 59% higher in patients with abnormal LFTs (OR=1.59, (95% CI 1.35 to 1.87) p<0.001) and remained significant though attenuated after adjusting for BNP, race and ethnicity and age (ORadj=1.31 (95% CI 1.09 to 1.57), p=0.004). Likelihood ratios for abnormal and normal LFTs were 1.2 (95% CI 1.21 to 1.28) and 0.76 (95% CI 0.68 to 0.84), respectively.ConclusionsA significant proportion (40%) of patients with suspected ADHF was missing LFTs in their ED workup. Among patients with LFTs, abnormal LFTs are associated with discharge diagnosis of ADHF after accounting for potential confounders, but their diagnostic value was relatively low. Future prospective studies are warranted to explore the role of LFTs in the workup of ADHF.

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Elevated Liver Enzymes: Emergency Department–Focused Management

Cited by 6 publications

References 58 publications

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department

Various stress stimuli rewire the profile of liver secretome in a p53-dependent manner

Use and diagnostic value of liver enzyme tests in the emergency department and subsequent heart failure diagnosis: a retrospective cohort study

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