Latest News on Liver Enzymes: Dec 2020

Is Liver Biopsy Useful in the Evaluation of Patients with Chronically Elevated Liver Enzymes?

Study Objective:To determine the diagnostic usefulness of percutaneous liver biopsy in evaluating patients with chronically elevated liver-associated enzymes.

Design:Comparison of diagnosis made before biopsy by one physician on the basis of a noninvasive work-up (history, physical examination, laboratory values, and imaging studies) and final diagnosis made after biopsy by a second physician formulated after review of all available noninvasive information and study of the biopsy specimen.

Setting:Referral-based gastroenterology clinic at a U.S. Navy medical center.

Patients:Sequential sample of 107 patients with elevated liver-associated enzymes for a minimum of 3 months. Ninety patients were eligible for study.

Interventions:The final diagnosis made by the second physician blinded to the first clinician’s diagnosis served as the criterion standard.

Measurements and Main Results:Four diagnostic groups were selected for analysis: Alcoholic liver disease, fatty liver, chronic necroinflammatory diseases, and miscellaneous. The positive predictive value of the prebiopsy diagnosis ranged from 88% (CI, 75% to 100%) for alcoholic liver disease to 56% (CI, 37% to 75%) for fatty liver. Higher elevations of transaminase values (greater than three times the upper limit of normal) correlated positively with increased prebiopsy diagnostic accuracy. Fatty liver was present in 19% of the cohort. Liver diseases requiring specific therapy other than alcohol abstinence were overlooked and diagnosed only after review of the biopsy in five cases. Conversely, four cases of liver disease, thought to require specific therapy on the basis of noninvasive work-up, were ruled out by biopsy.

Conclusion:The cause of chronic liver disease is best elucidated when the noninvasive work-up is complemented by review of a biopsy specimen. [1]

Diagnosis, Controversies, and Management of the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count

Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome has been recognized as a complication of preeclampsia—eclampsia for decades. Recognition of this syndrome in women with preeclampsia is increasing because of the frequency of blood test results that reveal unexpected thrombocytopenia or elevated liver enzymes. The diagnosis of HELLP syndrome requires the presence of hemolysis based on examination of the peripheral smear, elevated indirect bilirubin levels, or low serum haptoglobin levels in association with significant elevation in liver enzymes and a platelet count below 100,000/mm3 after ruling out other causes of hemolysis and thrombocytopenia. The presence of this syndrome is associated with increased risk of adverse outcome for both mother and fetus. During the past 15 years, several retrospective and observational studies and a few randomized trials have been published in an attempt to refine the diagnostic criteria, to identify risk factors for adverse pregnancy outcome, and to treat women with this syndrome. Despite the voluminous literature, the diagnosis and management of this syndrome remain controversial. Recent studies suggest that some women with partial HELLP syndrome may be treated with expectant management or corticosteroid therapy. This review will emphasize the controversies surrounding the diagnosis and management of this syndrome. Recommendation for diagnosis, management, and counseling of these women is also provided based on results of recent studies and my own clinical experience. [2]

Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy

Data are presented to define a unique group of preeclamptic/eclamptic patients with the finding of hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). This entity has been termed the HELLP syndrome and may occur when the usual clinical findings to diagnose severe preeclampsia are absent. Often the patient is given a nonobstetric diagnosis and treatment is withheld or modified. The possible pathophysiology of this syndrome, the management of the patient, and the maternal and neonatal outcomes are presented. Recognition of the clinical and laboratory findings of the HELLP syndrome is important if early, aggressive therapy is to be initiated to prevent maternal and neonatal death. The practicing obstetrician must be knowledgeable about this severe consequence of hypertension in pregnancy. [3]

Effects of Deionization Water Treated with Different Dose of Aluminum Chloride (AlCl3) on Creatinine and Liver Enzymes of Wistar Rats

The experiment was done in Department of Biochemistry and Molecular Biology. Aluminum chloride is used as coagulant for treatment the drinking water in AlMogran Water Treatment Plant, Khartoum State, Sudan. The study aimed at assessing the concentrations of liver enzymes (AST and ALT) and creatinine of Wister rats treated orally with Aluminum chloride by using deionization water. Fifty adults rats (average body weight about 109 g) were divided into five groups (10 male per group) as follows Group one (G1) represented control (without treatment), Group two (G2) received tap water, Group three (G3) received 50 mg/kg/day deionizing water treated with AlCl3, Group four (G4) received 60 mg/kg/day deionizing water treated with dose of AlCl3 and Group five (G5) received 70 mg/kg/day deionizing water treated with dose of AlCl3.

The treatments were given orally by gavages and continued daily for 60 days. Then blood sample was collected from each rat and measured for liver enzymes and kidney creatinine. The results showed that AlCl3 had led to a significant increase in liver enzymes and kidney creatinine (P≤ 0.05). In addition histopathology of liver of rats in G4 (60 mg \ kg Al C3) was showed severe necrosis, while the kidney showed packing, dilatation of renal tubules and degeneration compared with control group. [4]

Effect of Heroin Use on Liver Enzymes

Aim: A study of enzymes in the liver of heroin addicts enables a precise overview of the degree of the liver damages caused by heroin abuse, deviation of enzymes from the normal healthy values and degree of presence of hepatitis in intravenous heroin abusers.

Materials and Methods: The levels of three liver enzymes alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase in blood samples of the heroin addicts were investigated. The liver function tests were conducted on 25 serum samples of heroin addicts and 25 control serum samples. The age of male subjects was between 25-45 years.

Results and Discussion: In the investigated group of heroin addicts, serum samples showed changes in the enzyme levels. Nearly 52% heroin addicts showed elevated liver enzymes and 32% out of 52% heroin addicts showed elevated enzyme levels with positive HCV and HBsAg tests. The established changes correlated with the duration of heroin abuse and presence of HBV and HCV positive results. The study showed that the most prominent change is the elevation of enzymes and it is the only direct consequence of liver damage due to heroin use. [5]

Reference

[1] Van Ness, M.M. and Diehl, A.M., 1989. Is liver biopsy useful in the evaluation of patients with chronically elevated liver enzymes?.  Annals of Internal Medicine, 111(6), pp.473-478.

[2] Sibai, B.M., 2004. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics & Gynecology, 103(5), pp.981-991.

[3] Weinstein, L., 1982. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. American journal of obstetrics and gynecology, 142(2), pp.159-167.

[4] Salah, E. I., Sabahelkhier, M. K. and Adam, S. (2015) “Effects of Deionization Water Treated with Different Dose of Aluminum Chloride (AlCl3) on Creatinine and Liver Enzymes of Wistar Rats”, Annual Research & Review in Biology, 8(2), pp. 1-7. doi: 10.9734/ARRB/2015/20222.

[5] Farooqi, S., Altaf, T., Mubeen, H. and Raza, S. (2015) “Effect of Heroin Use on Liver Enzymes”, Journal of Advances in Biology & Biotechnology, 5(1), pp. 1-9. doi: 10.9734/JABB/2016/22047.

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