Diagnosis and Monitoring of Hepatic Injury. II. Recommendations for Use of Laboratory Tests in Screening, Diagnosis, and Monitoring

Abstract

Purpose: To review information on the use of laboratory tests in screening, diagnosis, and monitoring of acute and chronic hepatic injury. Data Sources and Study Selection: A MEDLINE search was performed for key words related to hepatic diseases, including acute hepatitis, chronic hepatitis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, and etiologic causes. Abstracts were reviewed, and articles discussing use of laboratory tests selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. Recommendations: Although many specific recommendations are made in the guidelines, only some summary recommendations are listed here. In acute hepatic injury, prothrombin time and, to a lesser extent, total bilirubin are the best indicators of severity of disease. Although ALT is useful for detecting acute and chronic hepatic injury, it is not related to severity of acute hepatic injury and only weakly related to severity of chronic hepatic injury. Specific tests of viral markers should be the initial differential tests in both acute and chronic hepatic injury; when positive, they are also useful for monitoring recovery from hepatitis B and C.

Evaluation of a logistic regression model for predicting liver necroinflammation in hepatitis B e antigen‐negative chronic hepatitis B patients with normal and minimally increased alanine aminotransferase levels

“…As the most sensitive factor for reflecting necrosis of liver cells and lesion of liver tissue, the ALT level can be affected by patients' demographics and other liver diseases. 23,24 Our study's results suggest that it is difficult to use the ALT level to reflect liver necroinflammation in HBeAg-negative patients with CHB who have minimal elevation of the ALT level.…”

Delayed intervention with a novel SGLT2 inhibitor NGI001 suppresses diet‐induced metabolic dysfunction and non‐alcoholic fatty liver disease in mice

“…H&E and Oil Red O staining showed whereas lipid accumulation was greatly diminished by treatment with NGI001 or dapagliflozin (Figure 4d). Next, we investigated markers of hepatic lipotoxicity related to liver inflammation, including GOT/aspartate transaminase and GPT/alanine transaminase (Cassidy & Reynolds, 1994;Dufour et al, 2000). The levels of serum GOT and GPT were higher in HFD mice, but these high levels were significantly lower in mice treated with NGI001 (30 mg·kg −1 ), indicating an amelioration of liver inflammation (Figure 4e produced by the liver, albumin, LDH, total bilirubin, and γ-glutamyltransferase did not differ among the groups (Figure 4gj).…”

Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare

“…2,3 The commercially available enzyme immunoassays (EIA) for IgM anti-HBc have been designed to detect only higher titers of the antibody, but IgM anti-HBc is present in approximately 10-15% of patients with CHB, especially in those with CHB-AF. 2,3 IgM anti-HBc in high titers had a high sensitivity (90-100%) and specificity (90-100%) for the diagnosis of acute HBV infection. [4][5][6] The results, however, were obtained by comparison of acutely HBV-infected patients with those with common CHB without an acute flare, even with healthy individuals who were only positive for anti-HBc.…”