PWE-196 Factors predicting mortality in acute severe gallstone pancreatitis
Henry L. JenkinsLC EwanYalaka Rami ReddyDennis ChangAmbareen KausarCarol E. HarrisDaren SubarSnehal LapsiaD Sebastian
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Abstract:
Introduction
The British Society of Gastroenterology (BSG) guidelines state that “Urgent therapeutic ERCP should be performed in patients with acute pancreatitis of suspected or proven gall stone aetiology who satisfy the criteria for predicted or actual severe pancreatitis”. The Cochrane review in 2012 suggested that ERCP does not affect morbidity and mortality and some patients with gallstones in the CBD will pass spontaneously.Aim
The aim of this study was to assess predictive factors of mortality and the need for ERCP in severe gallstone pancreatitis.Method
Data for patients who presented with acute severe biliary pancreatitis between January 2012 and April 2014 was collected. Data collected included predicted severity (Modified Glasgow score), liver function tests, white cell count, USS, ERCP and MRCP reports. Overall 90 day mortality was also recorded.Results
123 patients had predicted severe pancreatitis. On US 21 patients had a dilated CBD and 16 had CBD stone. 51% of patients (n = 63) had MRCP of which 22 patients had CBD stones. 60 patients had ERCP. In 17% (n = 21) no stone was found. 2 patients (3%) developed post ERCP pancreatitis.11% (n = 14)of the patients admitted with predicted severe acute pancreatitis died. On univariate analysis albumin (p = 0.003), alanine transaminase (ALT) (p= <0.05) but not ERCP was significant in predicting mortality. High white cell count demonstrated a trend towards predicting mortality (p = 0.08) but did not reach statistical significance. On multivariate analysis albumin (p = 0.41) and ALT (p = 0.005) retained statistical significance.Conclusion
Low serum albumin and ALT predicts mortality in severe GSP but ERCP does not and may precipitate further attacks of pancreatitis. Patients who have severe gallstone pancreatitis without deteriorating LFTs or cholangitis should have an MRCP to confirm stones in the CBD prior to ERCP.Disclosure of interest
None Declared.Keywords:
Univariate analysis
White blood cell
Aspartate transaminase
The impact of dengue on liver function was studied by biochemical tests on 125 male and 145 female patients diagnosed with this disease during an outbreak that extended from November 1987 to December 1988. Abnormal levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (G-GT) were observed in 93.3%, 82.2%, 7.2%, 16.3% and 83.0% of the patients, respectively. The elevation of transaminases was mild to moderate in most cases, but was 10-fold greater than the normal upper limit for AST and ALT in 11.1% and 7.4% of the patients, respectively. Initially, the level of AST was greater than that of ALT, increasing to maximum levels nine days after the onset of symptoms, then decreasing to normal levels within two weeks. Results of the biochemical tests did not differ significantly between the cases with and without hepatitis B or hepatitis C virus infection, but significantly higher elevations of AST, ALT, and G-GT were observed in patients with episodes of bleeding. Liver biopsies of two patients showed features of lobular hepatitis. Of the five fatal cases, three died of hepatic failure. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever infection should be considered in the differential diagnosis of hepatitis.
Aspartate transaminase
Elevated transaminases
Liver function
Viral Hepatitis
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Background: coronavirus-19 disease recently emerged as a global pandemic affecting the respiratory system. However, during the course of the illness, the disease can directly or indirectly involve other body organs including the liver. Objectives: This study aimed to determine the incidence of hepatic involvement and its clinical significance in COVID-19 patients. Patients and Methods: This cross-sectional single-center study was conducted on 112 patients who have an infection with Covid 19 (proved by polymerase chain reaction). Depending on infection severity, patients were categorized into three groups (according to the guidelines of the Chinese National Health Committee): mild, moderate, and severe cases. Blood samples were collected from each patient and liver function tests were conducted. Abnormal hepatic enzyme was considered when any enzyme (alanine transaminase, aspartate transaminase, and alkaline phosphatase) was more than the upper normal laboratory value. Categorical variables were presented as numbers and percentages and analyzed with a Chi-square test. A P≤ 0.05 was considered statistically significant. Results: Sixty-six patients (58.93%) had normal liver enzymes, while the other 46 (41.07%) had abnormal liver enzymes. The mean age of patients with elevated liver enzymes was 45.17±11.93 years which was significantly higher than that of normal liver enzymes patients (38.92±13.47 years). In severe cases, 45.65% of patients had elevated liver enzyme compared with 43.48% in moderate group and 10.87 % in mild group. Conclusions: Acute liver injury as indicated by hypertransaminasemia is a frequent finding in COVID-19 patients. Elderly patients with moderate to severe COVID-19 are more prone to hepatic involvement. Received: May, 2022 Accepted: July, 2023 Published: Jan 2024
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To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes.A longitudinal observational study.West Middlesex University Hospital, Twickenham.Ninety-four women with uncomplicated pregnancy who delivered at term.Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal.Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration.All LFTs were affected by delivery (P < 0.001), increasing by 88% (0-500%) on day 2 or day 5 for AST, 147% (0-1140%) on day 5 for ALT and 63% (0-450%) on day 5 or day 10 for GGT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P = 0.001, P = 0.033 respectively). The mean peak GGT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P = 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly.Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver-related illnesses, by facilitating the differentiation of physiological and pathological processes.
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Changes to enzymes responsible for liver function may be a sign of liver injury or disease. The enzymes alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and bilirubin are measured in blood tests. When ALT and AST are a little above normal limits, ultrasound (US) abdomen and US duplex Doppler abdomen are usually appropriate. US shear wave elastography abdomen (measures tissue stiffness), MR elastography abdomen, MRI abdomen without and with intravenous (IV) contrast with MR cholangiopancreatography (MRCP; special MRI for pancreas and liver), and CT abdomen/pelvis without IV contrast may be appropriate. When ALT and AST are above limits by a large amount, US abdomen, US duplex Doppler abdomen, and CT abdomen/pelvis with contrast are usually appropriate. MRI abdomen without and with contrast with MRCP, MRI abdomen without contrast with MRCP, and CT abdomen/pelvis without contrast may be appropriate. High ALP can result from liver disease or other causes. When both ALP and gamma-glutamyl transpeptidase are high, the cause is usually liver disease. US abdomen, MRI abdomen without and with contrast with MRCP, and CT abdomen/pelvis with IV contrast are usually appropriate. US duplex Doppler abdomen, MRI abdomen without contrast with MRCP, and CT abdomen/pelvis with contrast may be appropriate. High bilirubin levels (called hyperbilirubinemia) can result from a bile flow blockage, liver disease, or other causes. With hyperbilirubinemia, US abdomen, MRI abdomen without and with contrast with MRCP, MRI abdomen without contrast with MRCP, and CT abdomen/pelvis with contrast are usually appropriate. CT abdomen/pelvis without contrast may be appropriate. See the full appropriateness criteria for this topic at https://acsearch.acr.org/docs/3158167/Narrative.
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Background: COVID-19 pandemic has been one of the greatest challenges to the global healthcare system.Although the respiratory system is the main target of SARS-CoV-2 infection; other organs, exposure to the viral infection might also be a concern for CVID-19 affected patients especially the cardiovascular system and liver.Objective: To know the status of C-reactive protein (CRP)and Liver Function Tests (LFT) in Covid-19 positive patients before initiating any treatment in a tertiary care hospital.Methods: Age and sex-matched 40 cases were taken for the study who were hospitalized and COVID-19 infection had been confirmed by real-time RT PCR for COVID-19.Patients with a previous history of liver illness, renal disorders, chronic inflammatory conditions, malignancy and autoimmune disorders were excluded from the study.Results: Almost all the liver enzymes were higher than the normal levels as seen in aspartate transaminase (35%), alanine transaminase (22.5%), alkaline phosphatase (20%), and gamma-glutamyl transaminase (35%).And whenever the protein, especially albumin was low there was an increased value of CRP and correspondingly with increased total and direct bilirubin levels. Conclusion:In our study liver function test was altered even before starting any treatment for SARS-CoV-2 indicates that LFT can be a tool to assess multiorgan involvement whenever the patient is going for complication or cytokine storm by doing serial measurements of liver function.
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Abstract Aims The definition of metabolic syndrome (MS) continues to be debated and does not include abnormal liver function tests (LFTs). This study aims to determine: (1) the association between the five ATP3 MS diagnostic components and different LFTs, and (2) the association between raised LFTs and prevalent cardiovascular disease (CVD). Methods A total of 1357 patients, without alcoholism or known liver disease, from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Receiver operating characteristic (ROC) areas under the curve (AUC) were determined for associations between the ATP3 diagnostic components, and between LFTs and ATP3 diagnostic components. Results The range of ROC AUC for ATP3 diagnostic components was 0.60–0.77. Waist had the strongest association and blood pressure the weakest. The strength of association between ATP3 diagnostic components and gamma GT (GGT) was similar (0.63–0.72), but was less for alanine transaminase and aspartate transaminase. Using the ROC‐derived GGT cut‐off (men 27 IU, women 20 IU), those with MS and a high GGT had more CVD than those with MS and a low GGT, and those without MS (18% vs. 10% vs. 7%, respectively; P < 0.001). Among those with MS, after adjusting for covariates, the odds ratio of CVD was 2.66 (1.18–5.96) for a high GGT compared to a low GGT. CVD was not significantly more prevalent in MS patients with a low GGT compared to non‐MS patients. Conclusions We suggest that including a raised GGT in the criteria for MS could increase its predictive nature for CVD. Prospective studies are needed to confirm this finding.
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This study examines the levels of serum bilirubin, aspartate transaminase and alkaline phosphatase in adults with Plasmodium falciparum malaria. One hundred and six sets of liver function tests were obtained, and 63 (59.4%) patients had one of the above indices elevated outside the local reference range. Serum bilirubin and aspartate transaminase were relatively higher than alkaline phosphatase. Neither duration of illness nor severity of infection showed any significant correlation with any of the indices measured.
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ΣΚΟΠΟΙ: (i) Ο υπολογισμός της συχνότητας των αλλοιώσεων τύπου πρωτοπαθούς σκληρυντικής χολαγγειίτιδας (ΠΣΧ) ή/και χρόνιας παγκρεατίτιδας (ΧΠ) στη μαγνητική χολαγγειοπαγκρεατογραφία (magnetic resonance cholangiopancreatography, MRCP), σε παιδιά με ιδιοπαθή φλεγμονώδη νόσο του εντέρου (ΙΦΝΕ)· (ii) η διερεύνηση της αποτελεσματικότητας ορισμένων δεδομένων, συγκεκριμένα δημογραφικών, εργαστηριακών (ίδε δοκιμασίες ηπατικής λειτουργίας, liver function tests, LFTs) και απεικονιστικών (εκ της μαγνητικής εντερογραφίας και της αξιολόγησης της άνω κοιλίας στη μαγνητική τομογραφία), στην ανίχνευση των ανωτέρω αλλοιώσεων στον ίδιο πληθυσμό. ΜΕΘΟΔΟΙ: Τα δεδομένα 94 παιδιών με ΙΦΝΕ συσχετίστηκαν συγχρονικά με τη βασισθείσα στην MRCP διάγνωση. ΑΠΟΤΕΛΕΣΜΑΤΑ: Δεκαοκτώ (19.1%) συν ένας (1.1%) ασθενείς με αλλοιώσεις τύπου ΠΣΧ και ΧΠ, αντιστοίχως, σχημάτισαν την Ομάδα ΠΣΧ/ΧΠ (20.2%). Κατ’ αρχάς, τα δημογραφικά και απεικονιστικά δεδομένα δεν συσχετίστηκαν με το αποτέλεσμα της MRCP. Περαιτέρω, στην Ομάδα ΠΣΧ/ΧΠ ήταν σημαντικά υψηλότερες: (i) oι τιμές των LFTs περί την πρωτοδιάγνωση ΙΦΝΕ και περί την MRCP (πλην της γ-γλουταμυλικής τρανσφεράσης, γ-glutamyl transferase, γ-GT περί την MRCP)· και (ii) οι συχνότητες των παθολογικών τιμών των ασπαρτικής τρανσαμινάσης (aspartate transaminase, AST), αλανινικής τρανσαμινάσης (alanine transaminase, ALT) και γ-GT περί την πρωτοδιάγνωση ΙΦΝΕ, καθώς και των AST, ALT, γ-GT και άμεσης χολερυθρίνης (direct bilirubin, DBil) περί την MRCP. Ωστόσο, οι τιμές και οι συχνότητες των παθολογικών τιμών των LFTs κυμάνθηκαν χαμηλά στην ίδια ομάδα (~40-128% των ανώτερων φυσιολογικών ορίων, upper normal limits, UNL και ~15-53%, αντιστοίχως). Επιπλέον, οι AST, ALT και γ-GT περί την πρωτοδιάγνωση ΙΦΝΕ, καθώς και οι AST, ALT, γ-GT και DBil περί την MRCP, συνδέθηκαν με αυξημένο κίνδυνο απεικόνισης των επίμαχων αλλοιώσεων, επί εμφάνισης παθολογικών τιμών. Ακόμη, μία σημαντική γραμμική συσχέτιση ανέκυψε μεταξύ του ανωτέρω κινδύνου και των τιμών των: (i) AST, ALT, αλκαλικής φωσφατάσης (alkaline phosphatase, ALP), γ-GT και ολικής χολερυθρίνης (total bilirubin, TBil) περί την πρωτοδιάγνωση ΙΦΝΕ· και (ii) AST, ALT, ALP, γ-GT και DBil περί την MRCP. Τέλος, τα αποκρινόμενα στο μέγιστο άθροισμα ευαισθησίας και ειδικότητας όρια αποκοπής των LFTs έλαβαν χαμηλές τιμές (~33-156% των UNL), ενώ οι αντίστοιχες, προγνωστικές για τις αλλοιώσεις δοκιμασίες των AST και ALT περί την πρωτοδιάγνωση ΙΦΝΕ θεωρήθηκαν σχεδόν βέλτιστες (θετική/ αρνητική προγνωστική αξία: ~90%/~90%, ~80%/~90%, αντιστοίχως).ΣΥΜΠΕΡΑΣΜΑΤΑ: Ο αληθής επιπολασμός των αλλοιώσεων τύπου ΠΣΧ στα παιδιά με ΙΦΝΕ εμφανίζεται απροσδόκητα υψηλός, ενώ η απεικόνιση βλαβών τύπου ΠΣΧ ή/και ΧΠ κρίνεται πιθανή ακόμη και στην απουσία ισχυρώς συνηγορούντων βιοχημικών δεδομένων. Επίσης, ο κίνδυνος ανεύρεσης των αλλοιώσεων ελέγχεται αυξημένος επί απορρύθμισης μίας σειράς LFTs και γραμμικώς συσχετιζόμενος με αρκετές μεταβλητές του είδους. Περαιτέρω, ανάμεσα στις LFTs, οι τρανσαμινάσες περί την πρωτοδιάγνωση ΙΦΝΕ φαίνεται να παρέχουν τις καταλληλότερες δοκιμασίες πρόγνωσης της απεικόνισης των αλλοιώσεων. Πάντως, αν καθοριστούν όρια αποκοπής των LFTs για τη λήψη ενδεδειγμένης απόφασης διεξαγωγής MRCP στον υπό εξέταση πληθυσμό, αυτά οφείλουν να είναι αισθητά χαμηλά, ενδεχομένως εντός φυσιολογικών τιμών.
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Background: Liver damage is commonly seen in dengue infection, which can sometimes lead to acute liver failure. Although the exact causes of liver injury is unknown, direct viral injury, hypoxic injury due to vascular leakage and immune mediated liver damage are thought to contribute to liver involvement in dengue. Therefore, we proceeded to investigate the patterns of liver injury and the possible contributing factors in acute dengue infection. Methods & Materials: 55 adult patients with confirmed acute dengue infection were recruited during day 3 -5 of the illness and serial recordings of liver function tests, viral loads, serum IL10 and IL17 levels and the extent of fluid leakage were measureddaily until discharge from hospital. According to the 2011 WHO guidelines, 19 of these patients were classified as dengue haemorrhagic fever (DHF) and 36 were classified as dengue fever (DF). Results: Serum alanine transaminase (ALT), aspartate transaminase (AST), conjugated and unconjugated bilirubin, gamma glutamyl transaminase and alkaline phosphatase levels were highest on day 7 of illness in patients with DHF and DF. Serum albumin levels were only lower in patients with DHF. The peak in liver enzymes occurred 2 days after the peak of viraemia in patients with DHF and DF. The extent of the rise in liver enzymes did not correlate with the extent of vascular leak and there were no significant differences in any of the liver enzymes between patients with DF or DHF. In contrast, IL-17 levels were significantly associated with ALT levels (p = 0.02, Spearmans r = 0.17). IL-17 levels were significantly higher (p = 0.008) on day 5 of illness in patients with ALT levels > 4 times the upper limit of normal (mean 38.2 SE ± 10.1), when compared to those with lesser degree of liver involvement (10.3, SE ± 10.2). Although IL-10 were higher in patients with higher AST levels, this was not significant. Conclusion: Dengue associated liver injury appears to peak at day 7 of illness and appears to associate with serum IL-17 levels but not with the degree of fluid leakage or viraemia. Since IL17 was also shown to cause liver injury in dengue mice models, the mechanisms by which this occurs needs to be further investigated.
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To evaluate the influence of combined therapy of conventional and herbal medicines on liver function.This study was a retrospective chart review. A total of 138 patients with abnormal liver transaminase levels at the time of admission were included in this study. We evaluated the influence of combined therapy of conventional and herbal medicines on liver transaminase levels over a period of at least 2 weeks at Kyung Hee University Korean Medical Hospital. Analyses were performed using SPSS version 17.0 for Windows. Paired T-tests were used to examine the significance of differences in AST, ALT, and GGT levels at the time of admission and discharge.We found that combined therapy reduced levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT) to a statistically significant level. Specifically, there were 48, 66, 104 subjects who exhibited abnormal AST, ALT and GGT levels at admission, which was reduced to 13, 37, and 64 subjects after combined therapy, respectively. Some subjects exhibited worsening levels of liver transaminases after combined therapy, so we used the χ2 test to analyze the influence of combined therapy with conventional and herbal medicines on liver function according to initial liver transaminase levels. According to this analysis, ALT and GGT levels may be more important than AST levels in estimating the influence of combined therapy on patients with abnormal liver transaminase levels.Based on this retrospective chart review, combined therapy of conventional and herbal medicines would be considered relatively safe. Thus, if patients have abnormal ALT or GGT levels, caution should be taken when suggesting combined therapy with conventional and herbal medicines.
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