Diagnosis Of Liver Injury Research Articles

A study of the effect of antitubercular drugs on liver functions in newly diagnosed cases of tuberculosis during intensive phase of therapy in tertiary care hospital

Background: Antitubercular drugs are commonly associated with drug-induced liver injury (DILI), which can present as asymptomatic alterations in liver function test (LFT) to symptomatic hepatic injury and failure. Regular and frequent monitoring of LFT during intensive phase of therapy helps to identify early DILI and its complication. Aims and Objectives: The main objective was to evaluate the effects of antitubercular drugs on liver functions by early monitoring. Materials and Methods: A prospective observational study was conducted for 1 year among 97 newly diagnosed tuberculosis patients in tertiary care hospital. LFT was performed during baseline, at the end of 2nd week, and at end of intensive phase of treatment. Diagnosis of liver injury was based on DILI criteria and assessment of the clinical pattern of liver damage was done using “R value”. Results: Among 97 patients, 16 had experienced DILI and incidence was higher during the first visit. Aspartate aminotransferase (AST) and alanine aminotransferase were significantly altered during the first visit while AST and total bilirubin during the second visit. The number of parameters deranged was higher at the end of intensive phase than during the end of 2nd week. Cholestatic pattern (81.25 %) of liver injury was the most common type as per “R value”. According to DILI network severity index, the majority were categorized as “moderately-severe” and “moderate” during the first and second follow-up, respectively. Conclusion: The incidence of antitubercular drugs-induced liver injury was higher during the initial 2 weeks of treatment, but the derangement was more evident at the end of the intensive phase. Frequent and regular monitoring during the initial phase of treatment helps to detect early DILI which prevents the impending liver failure.

Ratiometric Detection of H2S in Liver Injury by Activated Two-Wavelength Photoacoustic Imaging.

Metformin is commonly used for clinical treatment of type-2 diabetes, but long-term or overdose intake of metformin usually causes selective upregulation of H2S level in the liver, resulting in liver injury. Therefore, tracking the changes of H2S content in the liver would contribute to the prevention and diagnosis of liver injury. However, in the literature, there are few reports on ratiometric PA molecular probes for H2S detection in drug-induced liver injury (DILI). Accordingly, here we developed a H2S-activated ratiometric PA probe, namely BDP-H2S, based Aza-BODIPY dye for detecting the H2S upregulation of metformin-induced liver injury. Due to the intramolecular charge transfer (ICT) effect, BDP-H2S exhibited a strong PA signal at 770 nm. Following the response to H2S, its ICT effect was recovered which showed a decrement of PA770 and an enhancement of PA840. The ratiometric PA signal (PA840/PA770) showed excellent H2S selectivity response with a low limit of detection (0.59 μM). Bioimaging experiments demonstrated that the probe has been successfully used for ratiometric PA imaging of H2S in cells and metformin-induced liver injury in mice. Overall, the designed probe emerges as a powerful tool for noninvasive and accurate imaging of H2S level and tracking its distribution and variation in liver in-real time.

Progress and prospects of biomarkers for liver injury in critically ill patients

Liver injury is an independent risk factor for worse prognosis of patients with critically ill.The criteria for diagnosis of liver injury are based on the levels of alanine aminotransferase(ALT ≥ 2 fold the upper limit of normality)or total bilirubin(TBIL≥ 68 μmol/L). All these classic indicators have limitation to early identify liver injury.Recently, accumulated evidences indicated that novel potential biomarkers for predicting liver injury are worth more attention due to quick response to liver injury up to 0.5-2 h. Here, we summarized these potential biomarkers including serum total bile acids, bile acids profiling, regulator of iron metabolism(transferrtin, ferritin and hepcidin), enzymes involved in mitochondria function(GLDH and MDH), key proteins for ornithine circulation pathway(Arg Ⅰ, OCT and ASS), hepatocytes-derived cytokines(CK18, HMGB1 and miR122)and immunologic regulator(MIF). Key words: Liver injury; Biomarker; Critically ill

Role of elevated liver transaminase enzymes in diagnosis of liver injury in cases after abdominal trauma

Background: Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. Delayed diagnosis of patients with severe liver injuries is associated with an adverse outcome. Diagnostic modalities include serial abdominal examination, focused abdominal sonography for trauma, computed tomography scanning, diagnostic peritoneal lavage. The objective of this study was to detect relationship between raise of serum levels of hepatic transaminase enzymes and liver injury, and if the degree of the rise may also correlate with the severity of hepatic injury after abdominal trauma. Methods: cross sectional, prospective study observational study of all patients admitted emergency department in Suez Canal university hospital. Patients with abdominal trauma were subdivided (according to either surgical record after abdominal exploration or CT scans reports released by radiology department) in two groups, group with liver injury (31) cases and those without liver injuries (31) cases. Results: As regard to alanine aminotransferases (ALT) our study showed that serum ALT was raised in 28 cases from 31 cases of liver injury and only 4 patients with raised serum ALT did not have liver trauma (sensitivity: 90.3%, specificity: 87% , CI: 88.7%). Regarding aspartate aminotransferases (AST) our study showed serum AST was raised in about 21 cases from 31 cases of liver injury and only 7 patients with raised serum AST did not have liver trauma (sensitivity: 93.5%, specificity: 77.4% , CI: 87.1%). Conclusions: An abnormal ALT and AST can predict the presence of hepatic injuries in abdominal trauma patients, while the level of the abnormality can determine the severity of the insult to the liver. Also we can conclude that ALT is more specific for liver injury more than AST, Although AST show high sensitivity for liver injury than ALT.

Is computed tomography necessary to determine liver injury in pediatric trauma patients with negative ultrasonography?

Abdominal trauma is the third most common cause of all trauma-related deaths in children. Liver injury is the second most common, but the most fatal injury associated with abdomen trauma. Because the liver enzymes have high sensitivity and specificity, the use of tomography has been discussed for accurate diagnosis of liver injury. Our study was based on retrospective analyses of hemodynamically stabil patients under the age of 18 who were admitted to the emergency department with blunt abdominal trauma. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly higher as a result of liver injury. In the patients whose AST and ALT levels were lower than 40IU/L, no liver injury was observed in the contrast-enhanced computed tomography (CT). No liver injury was detected in the patients with AST levels lower than 100IU/L. Liver injury was detected with contrast-enhanced CT in only one patient whose ALT level was lower than 100IU/L, but ultrasonography initially detected liver injury in this patient. According to our findings, abdominal CT may not be necessary to detect liver injury if the patient has ALT and AST levels below 100IU/L with a negative abdominal USG at admission and during follow-up.

Stable Patients With Blunt Liver Injury

The diagnosis and treatment of liver injury have changed dramatically in the past 30 years. Because abdominal computed tomography scan now refines the diagnosis of liver injury, the observation and nonsurgical treatment of stable patients with blunt liver injury is now the standard. The need to surgically intervene should be governed by the presence of hemodynamic instability or frank peritonitis. There is ample data that validate this assertion. Implications for nurses in critical care include patient/family education and advocacy of treatment decisions and astute monitoring of the patient while in critical care.

Problems of diagnosis of liver injury in pediatric practice.

1. The problems of diagnosis in liver injury, the lack of correlation between laboratory findings, biopsy and autopsy studies and the rapid clinical deterioration resulting in death in three cases are presented. 2. Biopsy studies in Case 1 (V.K) showed minimal necrotic changes which were neither severe nor diffuse enough to cause the marked hepatocellular dysfunction present. 3. Case II (G.C.B.) was cirrhosis clinically in an advanced stage, but even after autopsy and histopathologic studies, changes in the liver could not be placed under any particular category relating to cirrhosis of the liver. In spite of extensive bile thrombi there was no clinical jaundice. 4. In Case III (D.R.), there were signs of marked liver damage without signs of portal hypertension. The biopsy studies showed extensive necrotic changes with widespread commencing fibrosis encircling single cells and groups of cells in other places, fitting into the group of liver injury in children who seem to have a relentless, progressive liver damage with no remission which allows the regeneration and the formation of pseudo-lobules.