Abnormal Alkaline Phosphatase Research Articles

Association of baseline characteristics with adverse events (AEs) in the PROpel trial of olaparib (ola) plus abiraterone (abi) as first-line (1L) treatment for metastatic castration-resistant prostate cancer (mCRPC).

e17030 Background: The PROpel trial (NCT03732820) met its primary endpoint and showed a statistically significant radiographic progression-free survival benefit (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54–0.81; P<0.0001) with ola + abi vs placebo + abi in 1L mCRPC; whilst not statistically significant, overall survival (OS) was numerically prolonged (median 42.1 vs 34.7 months; HR 0.81, 95% CI 0.67–1.00; P=0.0544). To further inform clinical decision making, we provide exploratory post hoc analysis investigating the relationship between selected patient baseline characteristics and AEs for ola + abi. Methods: Anemia and venous thromboembolism events (VTEs) were identified as the only grade (Gr) ≥3 AEs or AEs of special interest reported in >20 (>5.0%) patients (pts) in the ola + abi arm (data cutoff 12 Oct 2022). Baseline characteristics were correlated with AEs using Cox regression by backwards elimination and analysis with AEs as dependent variables. Baseline characteristics assessed included: age (<70 or ≥70 y), time since diagnosis (<median or ≥median) , ECOG status (0 or 1), metastatic sites (visceral [yes or no], bone only [yes or no]), number of bone metastases (0, 1–4, 5‒9, 10‒20 or >20), Gleason score (<9 or 9–10), homologous recombination repair mutation status (HRRm, non-HRRm or unknown), race (white or non-white), prior docetaxel at metastatic hormone-sensitive prostate cancer (yes or no), pain (symptomatic or asymptomatic/mildly symptomatic), type of progression (prostate-specific antigen [PSA], radiographic or both), prior radiotherapy (yes or no) and albumin, creatinine, lactate dehydrogenase, alkaline phosphatase (ALP), hemoglobin (10<12 or ≥12) and log PSA levels. Results: 398 pts received ola + abi. 64 (16.1%) had Gr ≥3 anemia and 34 (8.5%) a VTE. Baseline characteristics correlated significantly with increased risk of these AEs as shown (Table); characteristics not shown were not associated with AEs. Conclusions: These results provide insight into which baseline characteristics correlate with the risk of Gr ≥3 anemia. Pts with abnormal ALP, pre-existing anemia, ECOG PS 1 or age ≥70 years could be at higher risk and the development of Gr ≥3 anemia during treatment with ola + abi should be monitored. Clinical trial information: NCT03732820 . [Table: see text]

Hypophosphatasia Presenting as a Chronic Diffuse Pain Syndrome with Extra-Articular Calcifications.

Hypophosphatasia is a rare genetic disease characterized by abnormal alkaline phosphatase activity and deficiency of bone and teeth mineralization. Hypophosphatasia is well known in pediatrics with typical presentations in children, but mild forms can also be present in adults and are difficult to detect. We present the case of a 50-year-old woman referred for pain management, with a previous diagnosis of fibromyalgia. The association of clinical features (diffuse pain syndrome, early dental loosening, personal history of two fractures with osteoporosis, and family history of osteoporosis) with radiographic (heterotopic calcifications of the yellow and interspinous lumbar ligaments) and biological (low levels of total alkaline phosphatase) indices was suggestive of hypophosphatasia, which was confirmed by genetic analysis. We review and discuss the association between hypophosphatasia, musculoskeletal pain, and calcium pyrophosphate deposition and the importance of raising the diagnosis of adult-onset hypophosphatasia when facing these two rheumatologic entities.

O117 Burosumab in the management of X-linked hypophosphataemia: a retrospective cohort study reviewing anthropometric and biochemical markers

Abstract Introduction Rickets is a bone disease caused by a defect in mineralization. When left untreated, it has lifelong Orthopaedic sequelae. Burosumab, an anti-fibroblast growth factor 23 monoclonal antibody, improves rickets severity, symptoms, and growth in children with X-linked hypophosphataemia (XLH) followed to 64 weeks in clinical trials. International dosing guidance recommends targeting normal serum phosphate concentration. However, some children may not achieve this despite maximal dosing. This study compares clinical outcomes in children with XLH on long-term burosumab treatment who achieved normal phosphate, vs those who did not. Methods Single-centre retrospective review of a large paediatric cohort with XLH treated with burosumab. We evaluated growth and biochemical markers of bone health in those who did compared to those who did not achieve normal plasma phosphate concentration. Results Fifty-five children with XLH with median age 11.7 [6.8–15.5] years were included. 27 (49%) had low plasma phosphate concentration, and 27 (49%) normal phosphate after a median burosumab treatment duration of 3.3 [IQR 2.6–3.7] years. 1 (2%) did not have a recent phosphate level recorded. No difference in growth was found between normal and abnormal phosphate groups (p = 0.9). A trend of superior growth in those with normal compared with abnormal alkaline phosphatase level was observed. Conclusion Young children with XLH experience sustained growth on long-term burosumab treatment, albeit without normal plasma phosphate concentration in many. Consideration should be made to changing burosumab dosing recommendations to target the normalisation of alkaline phosphatase instead of plasma phosphate concentration.

Hematological and biochemical profiles in children with cerebral palsy: A cross-sectional study.

Cerebral palsy is a common pediatric neurological problem that has multiple comorbidities, including nutritional issues. Hematological and biochemical parameters significantly affect the health status of patients with cerebral palsy, and till now very few studies have analyzed these parameters. This study aimed to describe the hematological and biochemical parameters of children diagnosed with cerebral palsy. This four-year observational study included children with cerebral palsy who were admitted to the Department of Pediatrics of a medical college teaching hospital.Hemoglobin, platelet count, white blood count (WBC), red blood cells (RBCs), packed cell volume, RBC indices, and biochemical parameters (urea, creatinine, total bilirubin, total protein, albumin, globulin, aspartate transaminase, alanine transaminase, electrolytes, calcium and alkaline phosphatase) were noted and values (mean, standard deviation, and interquartile range) presented. Age and gender-based analyses were performed. The average hemoglobin level was 11.48 mg/dl, platelet count was 301.24×109/L, and WBC count was 11.13 109/L. Anemia was observed more commonly in males younger than nine years of age. Of 282 patients, 14 (4.96%) had a platelet count of less than 150×109/L. Abnormal alkaline phosphatase levels were observed more commonly in patients who were younger than nine years of age and in females more than males, and the difference was statistically significant. Protein levels and calcium levels were similar between both age groups. Anemia was more common in younger patients and males with cerebral palsy. Abnormal bone turnover markers (alkaline phosphatase) were more common in young patients and females with cerebral palsy. Understanding the differential effect of age and gender on various investigational parameters will help improve care of children with cerebral palsy by initiating appropriate and timely clinical interventions, thereby providing a better quality of life.

Better performance of PIVKA-II for detecting hepatocellular carcinoma in patients with chronic liver disease with normal total bilirubin.

Serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a promising biomarker for hepatocellular carcinoma (HCC) surveillance. To identify the contributing factors related to the abnormal elevation of PIVKA-II level and assess their potential influence on the performance of PIVKA-II in detecting HCC. This study retrospectively enrolled in 784 chronic liver disease (CLD) patients and 267 HCC patients in Mengchao Hepatobiliary Hospital of Fujian Medical University from April 2016 to December 2019. Logistic regression and the area under the receiver operating characteristic curve (AUC) were used to evaluate the influencing factors and diagnostic performance of PIVKA-II for HCC, respectively. Elevated PIVKA-II levels were independently positively associated with alcohol-related liver disease, serum alkaline phosphatase (ALP), and total bilirubin (TBIL) for CLD patients and aspartate aminotransferase (AST) and tumor size for HCC patients (all P < 0.05). Serum PIVKA-II were significantly lower in patients with viral etiology, ALP ≤ 1 × upper limit of normal (ULN), TBIL ≤ 1 × ULN, and AST ≤ 1 × ULN than in those with nonviral disease and abnormal ALP, TBIL, or AST (all P < 0.05), but the differences disappeared in patients with early-stage HCC. For patients with TBIL ≤ 1 × ULN, the AUC of PIVKA-II was significantly higher compared to that in patients with TBIL > 1 × ULN (0.817 vs 0.669, P = 0.015), while the difference between ALP ≤ 1 × ULN and ALP > 1 × ULN was not statistically significant (0.783 vs 0.729, P = 0.398). These trends were then more prominently perceived in subgroups of patients with viral etiology and HBV alone. Serum PIVKA-II has better performance in detecting HCC at an early stage for CLD patients with normal serum TBIL.

Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty.

Serum alkaline phosphatase (ALP) is a biomarker for chronic low-grade inflammation along with hepatobiliary and bone disorders. High abnormal ALP levels in blood have been associated with metabolic bone disease and high bone turnover. All primary total hip and knee arthroplasties from 2005 to 2019 were queried from the National Surgical Quality Improvement Program database. Patients with available serum ALP levels were included and stratified to low (<44 IU/L), normal (44 to 147 IU/L), and high (>147 IU/L). A risk-adjusted multivariate logistic regression was used to analyze ALP as an independent risk factor of complications. The analysis included 324,592 patients, consisting of 11,427 low ALP, 305,977 normal ALP, and 7,188 high preoperative ALP level patients undergoing total joint arthroplasty. Adjusted multivariate logistic regression analysis showed high ALP level patients had an overall increased risk of readmission within 30 days of surgery compared with the control group (odds ratio [OR], 1.69; P < 0.01). High ALP patients also had an increased risk of postoperative periprosthetic fracture (OR, 1.6), postoperative wound infection (OR, 1.81), pneumonia (OR, 2.24), renal insufficiency (OR, 2.39), cerebrovascular disease (OR, 2.2), postoperative bleeding requiring transfusion (OR, 1.83), sepsis (OR, 2.35), length of stay > 2 days (OR, 1.47), Clostridium difficile infection (OR, 2.07), and discharge to a rehab facility (OR, 1.41) (all P < 0.05). A low ALP level was also associated with increased postoperative bleeding transfusion risk (OR, 1.12; P < 0.01) and developing a deep vein thrombosis (OR, 1.25; P = 0.03). Abnormal serum ALP levels in patients undergoing primary total joint arthroplasty are associated with increased postoperative periprosthetic fracture risk and medical complications requiring increased length of stay and discharge to a rehabilitation facility.

Minimal Risk of Drug-Induced Liver Injury With Molnupiravir and Ritonavir-Boosted Nirmatrelvir

Minimal Risk of Drug-Induced Liver Injury With Molnupiravir and Ritonavir-Boosted Nirmatrelvir

Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients.

BACKGROUNDAbnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understoodAIMWe aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.METHODSThis retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosisRESULTSA total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilationCONCLUSIONAbnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.

Impact of COVID-19 on Liver Enzymes: A Retrospective Study

Introduction: The global pandemic of novel Coronavirus Disease- 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has spread worldwide crippling the healthcare system. Besides the respiratory system, COVID-19 patients show signs of various degrees of liver damage, the mechanism and implication yet undeciphered. Hence, in this study, we aim to find out pattern and trend of derangement in liver functions in COVID-19 patients. Aim: To depict the pattern and trend of liver enzymes in COVID- 19 admitted patients without history of liver disease. Materials and Methods: The study was conducted as a single centred, retrospective, observational study, from June 2020 till December 2020. It included 1909 admitted COVID-19 positive patients diagnosed via either nasopharyngeal or oropharyngeal swab by Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR). The COVID-19 positive patients were divided into four groups Group I: Age- 15-20 years; 150 patients, Group II: Age 21-40 years; 645 patients, Group III: Age 41-60 years; 560 patients, Group IV: Age &gt;60 years; 554 patients. Abnormality in liver tests was defined as greater than three times of upper limit of normal reference range Alanine Transaminase (ALT) &gt;120 U/L, Aspartate Transaminase (AST) &gt;120 U/L as Hepatocellular injury, greater than two times of upper limit of normal reference range Alkaline Phosphatase (ALP) &gt;250 U/L as Cholestatic Injury (CSI). The statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 25.0. Results: It was found that with respect to ALT levels, males in age 21-60 years, whereas females in two extremes of age 15-20 and &gt;60 years age were the most affected. Whereas, females in age group &lt;40 years were more affected with higher AST activity. With respect to abnormal ALP levels female in age group &lt;40 years were most affected but males were most affected in age group &gt;40 years. Conclusion: Irrespective of age and gender, abnormality in liver enzymes was observed. Liver Function Tests (LFT) are a part of routine investigations carried out at the time of admission; its abnormalities may guide us in devising strategy to prioritise patient management in correlation with inflammatory markers.

How do I investigate abnormal alkaline phosphatase?

How do I investigate abnormal alkaline phosphatase?

Dynamic changes in liver function parameters in patients with coronavirus disease 2019: a multicentre, retrospective study

BackgroundLiver injuries have been reported in patients with coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical role played by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsIn this multicentre, retrospective study, the parameters of liver function tests in COVID-19 inpatients were compared between various time-points in reference to SARS-CoV-2 shedding, and 3 to 7 days before the first detection of viral shedding was regarded as the reference baseline.ResultsIn total, 70 COVID-19 inpatients were enrolled. Twenty-two (31.4%) patients had a self-medication history after illness. At baseline, 10 (14.3%), 7 (10%), 9 (12.9%), 2 (2.9%), 15 (21.4%), and 4 (5.7%) patients already had abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and total bilirubin (TBIL) values, respectively. ALT and AST abnormal rates and levels did not show any significant dynamic changes during the full period of viral shedding (all p > 0.05). The GGT abnormal rate (p = 0.008) and level (p = 0.033) significantly increased on day 10 of viral shedding. Meanwhile, no simultaneous significant increases in abnormal ALP rates and levels were observed. TBIL abnormal rates and levels significantly increased on days 1 and 5 of viral shedding (all p < 0.05). Albumin abnormal decrease rates increased, and levels decreased consistently from baseline to SARS-CoV-2 clearance day (all p < 0.05). Thirteen (18.6%) patients had chronic liver disease, two of whom died. The ALT and AST abnormal rates and levels did not increase in patients with chronic liver disease during SARS-CoV-2 shedding.ConclusionsSARS-CoV-2 does not directly lead to elevations in ALT and AST but may result in elevations in GGT and TBIL; albumin decreased extraordinarily even when SARS-CoV-2 shedding ended.

Evaluation of hepatic enzymes activities in COVID-19 patients

SARS-CoV-2 or Coronavirus disease 2019 (COVID-19) outbreak which caused by the severe acute respiratory syndrome, has rapidly spread over the world. The exact mechanism how this virus will affect the liver remained elusive. The aim of this study was to evaluate the liver function in patients with severe acute respiratory syndrome coronavirus 2 and potential causes of hepatic enzymes disease in these patients. Clinical characteristics and laboratory findings were collected from patients with COVID-19 who were admitted to the corona center in Erbil city/Kurdistan region of Iraq, from March 10 to July 10, 2020. Serum was collected from patients with COVID-19 and liver enzyme tests were measured. Liver alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL) were analyzed in these patients. Of the 74 patients, 25 (34.7%) had abnormal ALT activity, 28 (40%) had abnormal AST activity, 12 (20.3%) had abnormal ALP activity, and 39 (52.7%) had abnormal total bilirubin P-value < 0.05. The inflammatory biomarkers CRP and IL-6 in COVID-19 patients with abnormal liver function test (4.9 ± 1.0 mg/dl) and (231.2 ± 35.7 pg/ml) respectively. The levels of both biomarkers were statistically significantly higher than COVID-19 patients with normal liver function test (2.1 ± 0.5 mg/dl) and (2.1 ± 0.5 mg/dl) respectively, P-value < 0.05. However, CRP and IL-6 were not statistically significant different between male and female COVID-19 patients P-value < 0.05. In conclusion, we found that most of the patients with SARS-CoV-2 have abnormal hepatic enzyme activities and that is might related to virus replication in the liver.

P45 Effect of One Anastomosis Gastric Bypass on Liver Function Tests: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb

IntroductionThe effect of One Anastomosis Gastric Bypass (OAGB) on Liver Function Tests (LFTs) is unclear. The purpose of this study was to find out the effect of OAGB on LFTS and also if a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200).MethodsWe investigated our prospectively maintained records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit.ResultsA total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 -July 2018. There were significant improvements in Gamma-Glutamyl-Transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of Alkaline Phosphatase (ALP) and albumin at 1 and 2 years follow up. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150, and in Alanine Transaminase (ALT) levels at 1 year follow up. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. There was no significant increase in the number of abnormal values for any of the tests in either group at both follow-up points. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients.ConclusionThis study demonstrates the overall safety of OAGB with regards to its effect on LFTs with no remarkable difference between OAGB-150 and OAGB-200.

Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children.

Given their established role in hepatic function and insulin resistance for adults, early screening of type 2 diabetes mellitus (T2DM) in the pediatric population may potentially be improved by the assessment of elevated liver enzymes. Our study enrolled 151 nondiabetic children aged 10-14years. Patients were assessed for demographics and five risk factors for T2DM. The levels of γ-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) levels were determined in serum samples. The effects of demographics and risk factors on abnormal liver enzyme levels were assessed with univariate chi-square analyses and also with multivariate logistic regression analyses, which were controlled for gender. Frequencies for abnormal liver enzyme values were as follows: 13 (9%) for GGT, 5 (3%) for ALT, and 20 (13%) for ALP. Across analyses, two results were consistently statistically significant. Females were more likely to have abnormal ALP levels, and patients with BMI percentile≥95% and with acanthosis nigricans were more likely to have abnormal GGT levels. Our study suggests GGT as potential marker for T2DM discovery in children. Subsequent long-term longitudinal studies would help to more clearly delineate GGT's association with T2DM. Additionally, future studies that elucidate the molecular contribution of GGT elevation to T2DM pathogenesis are needed.

Effect of one anastomosis gastric bypass on liver function tests: A comparison between 150 cm and 200 cm biliopancreatic limbs.

Context:Some studies have shown that one anastomosis gastric bypass (OAGB) results in the derangement of liver function tests (LFTs). We wanted to study this in our patients.Aims:The aims are to study the effect of OAGB on LFTs and to compare the effect of a biliopancreatic limb (BPL) of 150 cm (OAGB-150) to a BPL of 200 cm (OAGB-200).Settings and Design:The study was a retrospective cohort study conducted at a university hospital.Materials and Methods:Information was obtained from our prospectively maintained database and hospital's computerised records.Statistical Analysis:A P < 0.05 was regarded statistically significant; however, given the number of variables examined, findings should be regarded as exploratory.Results:A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 and July 2018. There were significant improvements in gamma-glutamyl transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of alkaline phosphatase (ALP) and albumin at 1 and 2 years. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150 and in alanine transaminase levels at 1 year. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients.Conclusions:This exploratory study demonstrates the overall safety of OAGB with regard to its effect on LFTs, with no remarkable difference between OAGB-150 and OAGB-200.

Evaluation of hepatic enzymes activities in COVID-19 patients in Kurdistan region of Iraq.

SARS-CoV-2 or Coronavirus Disease 2019 (COVID-19) outbreak which caused by the severe acute respiratory syndrome, has rapidly spread over the world. The exact mechanism how this virus will affect the liver remained elusive. The aim of this study was to evaluate the liver function in patients with severe acute respiratory syndrome coronavirus 2 and potential causes of hepatic enzymes disease in these patients. Clinical characteristics and laboratory findings were collected from patients with COVID-19 who were admitted to the corona center in Erbil city/Kurdistan region of Iraq, from March 10 to July 10, 2020. Serum was collected from patients with COVID-19 and liver enzyme tests were measured. Liver Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP), and Total Bilirubin (TBIL) were analyzed in these patients. Of the 74 patients, 25 (34.7%) had abnormal ALT activity, 28 (40%) had abnormal AST activity, 12 (20.3%) had abnormal ALP activity, and 39 (52.7%) had abnormal total bilirubin. In conclusion, we found that most of the patients with SARS-CoV-2 have abnormal hepatic enzyme activities and that is related to virus replication in the liver.

Correlation between Biochemical Features and Outcomes of Preoperative Imaging (SPECT-CT And Ultrasound) in Primary Hyperparathyroidism

Primary hyperparathyroidism is the third most common endocrine disorder, diagnosed by elevated parathyroid hormone (PTH) in hypercalcaemia. Several biochemical factors have been described to suggest severity of disease and may be correlated with preoperative imaging.This was a retrospective study of patients who underwent parathyroidectomy over a 3-year period. Preoperative calcium, PTH, vitamin D levels, ALP (alkaline phosphatase), vitamin D, serum phosphate and US and SPECT-CT positivity was noted.176 patients underwent parathyroidectomy and these were divided into 4 groups based on preoperative calcium. Overall, 61% of patients showed concordance between imaging and operative findings. Severe hypercalcaemia was associated with higher PTH levels, lower vitamin D levels, an increased rate of abnormal ALP levels, lower phosphate, male gender and highest rate of imaging concordance. Imaging positivity was associated with severe hypercalcaemia and elevated PTH levels. Level of PTH >125 pmol/L and hypercalcaemia >2.8 mmol/L are the most accurate cut-off levels for scan positivity.Biochemical factors associated with severity of the disease are directly correlated with positivity of preoperative imaging while ALP and vitamin D did not influence the preoperative imaging positivity but are associated with disease adversity. Serum phosphate level independently predicted results of parathyroid US.

Abstract 14229: Hepatobiliary Markers in Minority Heart Failure Patients; Echocardiography and Clinical Outcomes

Introduction: AHA sponsored guidelines and studies have focused on cardiac disease and particular heart failure (HF) profiles among minorities like African, Hispanic, and Asian Americans. Previous studies on liver function tests (LFT) in HF patients, like aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase (ALP), and bilirubin (Bili), have underrepresented minority groups in study cohorts. We investigated the relationship between LFT levels with echocardiographic (ECHO) findings and readmission outcomes among minority patients at the Heart Health Center (HHC) of NYC Health + Hospitals, Kings County, in Brooklyn, New York. Hypothesis: In minority HF patients, LFT levels are associated with ECHO parameters, and LFT abnormalities are associated with increased risk of admission. Methods: Retrospective review was performed of patients in the HF clinic at the HHC, and during acute HF exacerbation admission from November 2017 - November 2018, with hospitalization monitored through November 2019. Baseline and admission LFT levels were obtained. While abnormal AST, ALP, and Bili levels were classified by the hospital’s laboratory range, abnormal ALT levels were classified based on national gastroenterology guidelines. Regression analysis was used to examine the relationship between LFT levels during acute HF exacerbation and ECHO parameters. Odds ratio (OR) and confidence interval (CI) were used for analysis of readmission outcomes. Results: Among 586 HF patients, there was an increased risk of hospitalization with baseline elevations in AST (OR 2.30, CI 1.24 - 4.25, p = 0.008) and ALP (OR 1.99, CI 1.10 - 3.64, p = 0.023). In those hospitalized with acute HF (n = 147), Bili was positively correlated with mitral valve (MV) EA ratio (r = 0.28, p = 0.002) and tricuspid regurgitation max velocity (r = 0.21, p = 0.004). ALT positively correlated with mean MV e’ velocity (r = 0.23, p = 0.009) and negatively correlated with aortic valve (AV) mean velocity (r = -0.24, p = 0.001). Conclusions: Understanding the association of ECHO findings and risk of hospitalization in minority patients with baseline and acute HF LFT levels has crucial implications for the identification of high risk patients and for the development of patient centered HF care strategies.

S1587 Unusual Explanation for Elevated Alkaline Phosphatase: A Case Report

INTRODUCTION: Gastroenterologists often evaluate abnormal alkaline phosphatase (ALP) levels – which can indicate liver dysfunction. This case describes persistent ALP levels that were alleviated by resection of a sex cord-stromal tumor (SCT) with presentation confounded by cholecystitis. To our knowledge this case highlights the first case of this tumor type being implicated in elevated ALP. CASE DESCRIPTION/METHODS: A 52-year-old female presented with right upper quadrant pain, elevated ALP and suspected biliary obstruction. Upon examination, symptoms were attributed to a dilated common bile duct and gallstones with ALP levels of 794 units/L. After ERCP and laparoscopic cholecystectomy, ALP improved (764 units/L) without normalizing, all other symptoms resolved. Six months later the patient presented with left lower quadrant pain, palpable mass and rising ALP (1,108 units/L). Abdominal and pelvic CT showed a 14 × 12 × 16 cm complex solid heterogeneously enhancing pelvic mass. An exploratory laparotomy was performed with a bilateral salpingo-oophorectomy, pelvic washings and omentectomy, a 15 cm left ovarian tumor was discovered and removed. ALP normalized following these procedures. On gross examination the tumor had a variegated gray-brown-yellow solid cut surface. Histologically the tumor grew in diffuse sheets and vague nests with areas of necrosis. The tumor demonstrated grade 1-2 nuclear atypia with high mitotic activity and no Reinke crystals. A diagnosis of SCT not otherwise specified was rendered. The tumor invaded the mesovarium connective tissue and sigmoid colon serosa. No obvious disease was found outside the pelvis and pelvic washings were negative for malignancy. The tumor was staged at IIb and characterized as malignant given the infiltration into surrounding tissue, large size, high mitotic activity, necrosis and grade 1-2 atypia (Figure 1). DISCUSSION: This case is significant due to the unusual presentation of this rare tumor. The elevated ALP improved after gallstone removal and cholecystectomy but never normalized, likely the ALP at initial presentation was related to the undiagnosed SCT. Following SCT resection the ALP normalized quickly suggesting the tumor resection prompted normalization (Figure 2). In conclusion, this case represents an unusual presentation of a gynecological malignancy with significantly elevated ALP confounded by an initial presentation consistent with biliary tract disease. Only after successful removal of the tumor did the elevated ALP resolve.Figure 1.: Hematoxylin and eosin stained sections of this steroid cell tumor demonstrating malignant features including cytologic atypia (a, ×10), high mitotic activity including an atypical mitosis (b, ×20) and areas of necrosis (c, ×10).Figure 2.: Graphical representation of reported total measured ALP levels. Date of collection is shown on the x-axis and concentration in Units/L on the y-axis. The green text highlights date of cholecystectomy. The red vertical line and red text highlight date of NOS SCT resection. ALP normal range: 45–117 units/L.

Liver damage at admission is an independent prognostic factor for COVID-19.

Abnormal liver function is a common form of extra-pulmonary organ damage in patients with coronavirus disease 2019 (COVID-19). Patients with severe COVID-19 have a higher probability and progression of liver injury than those without severe disease. We aimed to evaluate the prognosis of liver injury in patients with COVID-19. We retrospectively included 502 patients with laboratory-confirmed SARS-CoV-2 infection. Clinical features and survival of patients with and without liver injury were compared. Cox proportional hazards models were used to determine the variables that might have an effect on survival. Among the 502 patients enrolled, 301 patients had abnormal liver function with increased neutrophil count, C-reactive protein, creatinine, troponin I (TnI), D-dimer, lactose dehydrogenase and creatine kinase. Patients with abnormal liver functions had a higher mortality rate (28.9% vs 9.0%, P < 0.001), a higher ratio of male sex (65.1% vs 40.8%, P < 0.001) and a higher chance of developing systemic inflammatory response syndrome (53.5% vs 41.3%, P = 0.007). Among patients with abnormal liver functions, patients with grade 2 liver damage (with both abnormal alanine aminotransferase or aspartate aminotransferase levels and abnormal alkaline phosphatase or gamma-glutamyl transpeptidase levels) had a higher ratio of male patients, elevated neutrophil count, procalcitonin, D-dimer levels and mortality rate. Multivariate Cox regression analyses suggested that the grade of liver damage (hazard ratio: 1.377, 95% confidence interval: 1.000-1.896, P = 0.049) was an independent predictor of death. Patients with COVID-19 and abnormal liver functions have a higher mortality than those with normal liver functions. Liver damage is an independent prognostic factor of COVID-19.