Liver enzyme alteration: a guide for clinicians

Giannini, Edoardo G.; Testa, Roberto; Savarino, Vincenzo

doi:10.1503/cmaj.1040752

Cited by 1,483 publications

(1,160 citation statements)

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“…Thus, it can be seen that analysis of the behavior of these enzymes clearly showed the cause-effect relationship between I/R injury to the liver graft and increased blood aminotransferase levels occurring in the two groups studied, as reported in the literature 22 . On the basis of this observation, there is no way to predict the type of postoperative course of patients submitted to OLT based on ALT and AST levels.…”

Section: Resultssupporting

confidence: 77%

Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation?

et al. 2013

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A análise conjunta do MELD pós-operatório, do base excess e dos níveis séricos de lactato pode ser usada como um índice prognóstico para pacientes submetidos a transplante de fígado? ABSTRACT PURPOSE:The objective of the present study was to evaluate the postoperative levels of classical or pure MELD and changes in lactate or base excess (BE) levels as possible predictive factors of the type of outcome of patients submitted to orthotopic liver trasplantation (OLT). METHODS:The study was conducted on 60 patients submitted to OLT at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, between October 2008 and March 2012. The 30 latest survivor (S) and non-survivor (NS) cases were selected.All liver transplants were performed using the piggy-back technique. ALT, AST, BE and blood lactate values were determined for each group at five time points (immediate preoperative period, end of hypothermal ischemia, 5 and 60 minutes after arterial revascularization and in the immediate postoperative period, when the postoperative MELD was also calculated. RESULTS:The aminotransferases reached a maximum increase 24 hours after surgery in both the S and NS groups. There was a significantly higher increase in BE and blood lactate in the NS group, especially after 5 minutes of afterial reperfusion of the graft, p<0.05. There was no significant difference in preoperative MELD between groups (p>0.05), while the postoperative MELD was higher in the NS than in the S group (p<0.05) CONCLUSION: Joint analysis of postoperative MELD, BE and blood lactate can be used as an index of severity of the postoperative course of patients submitted to liver transplantation. . Avaliou-se para cada grupo, os valores ALT, AST, de base excess (BE) e lactato sanguíneos em cinco momentos (pré-operatório imediato, no final da isquemia hipotérmica, 5 e 60 minutos após a revascularização arterial e no pós-operatório imediato, quando também foi calculado o MELD pós-operatório. RESULTADOS:Com relação às aminotransferases, houve um aumento máximo após 24 horas de pós-operatório em ambos os grupos S e NS. Houve aumento significativo dos níveis de BE e lactato sanguíneo significativamente maior no grupo NS, sobretudo nos tempos após 5 minutos de reperfusão arterial do enxerto, p<0,05. Não houve diferença significativa entre o MELD pré-operatório em ambos os grupos (p>0,05). O MELD pós-operatório foi maior no grupo NS do que no grupo S (p<0,05). CONCLUSÃO:A análise conjunta do MELD pós-operatório, do BE e do lactato sanguíneo pode ser usada como índice de gravidade da evolução pós-operatória de pacientes submetidos ao OLT.Descritores: Ácido Láctico, Transplante de Fígado, Índice de gravidade de doença, Prognóstico.

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Section: Resultssupporting

confidence: 77%

Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation?

et al. 2013

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“…In agreement with others, HCA-bearing GSD-Ia patients have mildly elevated serum levels of ALT and AST with an AST:ALT ratio of 1.27. A ratio of AST:ALT greater than 1 is highly suggestive of liver disease (27) and has been associated with advanced alcoholic liver disease (31) and chronic hepatitis C-mediated liver cirrhosis (32). The elevated levels in our patients are therefore consistent with the potential for hepatic damage.…”

Section: Discussionsupporting

confidence: 66%

“…The HCA-bearing GSD-Ia patients had mildly elevated serum levels of both enzymes. A ratio of AST:ALT greater than 1 is highly suggestive of liver disease (27) and the ratios of AST:ALT in HCA-bearing and HCA-nonbearing GSDIa patients were 1.27 and 1.11, respectively. Serum ALP levels between the two GSD-Ia patient groups were similar, both were above the normal references values of 40-120 IU/L (Fig.…”

Section: Human Gsd-ia Patients Exhibit Elevated Blood Neutrophil Counmentioning

confidence: 99%

Necrotic foci, elevated chemokines and infiltrating neutrophils in the liver of glycogen storage disease type Ia

Kim

Weinstein

Starost

et al. 2008

Journal of Hepatology

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Background/Aims-Glycogen storage disease type Ia (GSD-Ia) patients manifest the long-term complication of hepatocellular adenoma (HCA) of unknown etiology. We showed previously that GSD-Ia mice exhibit neutrophilia and elevated serum cytokine levels. This study was conducted to evaluate whether human GSD-Ia patients exhibit analogous increases and whether in GSD-Ia mice a correlation exists between immune abnormalities and, biochemical and histological alterations in the liver.Methods-Differential leukocyte counts and cytokine levels were investigated in GSD-Ia patients. Hepatic chemokine production, neutrophil infiltration, and histological abnormalities were investigated in GSD-Ia mice.Results-We show that GSD-Ia patients exhibit increased peripheral neutrophil counts and serum interleukin-8 (IL-8). Compared to normal subjects, HCA-bearing GSD-Ia patients have a 2.8-fold higher serum IL8 concentration, while GSD-Ia patients without HCA have a 1.4-fold higher concentration. Hepatic injury in GSD-Ia mice is evidenced by necrotic foci, markedly elevated infiltrating neutrophils, and increased hepatic production of chemokines.Conclusion-Peripheral neutrophilia and elevated serum chemokines are characteristic of GSDIa with HCA-bearing GSD-Ia patients having the highest serum IL-8. In GSD-Ia mice these elevations correlate with elevated hepatic chemokine levels, neutrophil infiltration, and necrosis. Taken together, peripheral neutrophilia and increased serum chemokines may indicate hepatic injuries in GSD-Ia

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“…They are typically used in conjunction with alkaline phosphatase, gamma glutamyl transpeptidase, bilirubin, albumin, and prothrombin time to determine the pattern (cholestatic or hepatic) and severity of liver dysfunction. 4,5 These patterns along with a thorough history and physical examination can narrow a very broad differential for liver pathology to more specific causes. The aminotransferases, however, are not confined to the liver.…”

Section: Discussionmentioning

confidence: 99%