Interpretation of abnormal liver chemistries in the hospitalized patient

Abstract

Abnormalities of liver chemistry tests (LCTs) in hospitalized patients are common and their evaluation is different from that performed in outpatient settings. This review focuses on the evaluation of new-onset liver chemistry abnormalities in the hospitalized patient. CORRESPONDENCE

Hydralazine-induced liver injury: a review and discussion

“…When first suspecting DILI, an assessment of symptoms and liver enzymes aberrations for RUCAM scoring helps in the assessment for a potential aetiology. The R value and type of liver injury pattern can progress over time, with most acute DILI cases presenting as a hepatocellular pattern and chronic DILI presenting as mixed or cholestatic pattern 26. In our case, as shown in table 1, our patient initially had an R value of 5.5, indicating a hepatocellular injury.…”

“…Acute DILI can be considered with symptoms lasting less than 6 weeks; subacute, if lasting 6 weeks to 6 months; or chronic, if lasting more than 6 months 25. Further DILI classification is based on the type of injury pattern: hepatocellular, cholestatic or mixed, as described in figure 1 26–28. The pattern type is determined by calculating the R value, which is defined as serum ALT/upper limit of normal (ULN) divided by the serum ALP/ULN (ALT/ALT ULN ÷ ALP/ALP ULN) 28.…”

Liver Injury Patterns and Hepatic Toxicity among People Living with and without HIV and Attending Care in Urban Uganda

“…It is common for ambulatory patients to have elevated liver enzymes without obvious signs of liver disease especially in the context of HIV/AIDS [ 3 , 4 ]. Evaluation for liver injury patterns based on liver chemistry parameters provides guidance on approach of diagnostic efforts geared towards narrowing down on possible causes of the observed liver injury [ 5 ].…”

“…In cholestatic liver injury, we mainly observe an elevation of the alkaline phosphatase serum levels (ALP) and gamma glutamyl transferase (GGT) which involves mainly the bile duct or presents as infiltrative disease [ 5 , 6 ]. A number of liver diseases can present with the same pattern of liver injury; thus, a detailed clinical history, examination, and other diagnostic procedures remain necessary for a more comprehensive assessment in narrowing down on a possible cause [ 5 ]. Viral hepatitis, drug-induced hepatitis, alcoholic liver disease, and nonalcoholic hepatosteatosis usually present as hepatocellular liver injury.…”