Liver Function Tests In Patients Research Articles

Hepatobiliary manifestations in patients with ulcerative colitis: a retrospective analysis.

Inflammatory bowel diseases (IBDs) are often associated with altered liver function tests (LFTs). There is little data on the relationship between abnormal LFT and IBD. Our study aimed to evaluate the prevalence and etiology of elevated LFT in patients with ulcerative colitis (UC) and to determine whether there is an association with clinical and demographic parameters. The clinical records of the Gastroenterology Outpatients Clinic at a single center were reviewed and screened for patients with UC from 2005 to 2014. In total, 263 patients were included. Patients with Crohn's disease (CD), colitis indeterminate, and colitis of other origins were excluded. Abnormal LFT and liver injuries were analyzed. A cohort of 182 patients was analyzed (114 males, 68 females; mean age = 50.2 ± 16.1 years). 58 patients had already been diagnosed with a hepatobiliary disorder. Patients with a known hepatobiliary disorder suffered from UC for a significantly longer duration. Elevated LFT in patients without known hepatobiliary disorders was 69.4%. Liver injury was found in 21.8%. A transient increase in abnormal LFT was shown in 59 patients (68.6%), a persistent increase was found in 27 patients (31.4%). Treatment with thiopurines was a risk factor for persistent elevated LFT (p = 0.029), steroids had a protective impact (p = 0.037). This study clearly highlights the importance of screening for hepatobiliary disorders and abnormal LFT in patients with UC, as the prevalence of hepatobiliary disorders and abnormal LFT is detected very often among this patient group.

Liver function tests in patients with hypertension in primary care: a prospective cohort study.

Liver function tests (LFTs) are frequently used to monitor patients with hypertension in UK primary care. Evidence is lacking on whether testing improves outcomes. To estimate the diagnostic accuracy of LFTs in patients with hypertension and determine downstream consequences of testing. Prospective study using the Clinical Practice Research Datalink (CPRD). In total, 30 000 patients with hypertension who had LFTs in 2015 were randomly selected from CPRD. The diagnostic accuracy measures for eight LFT analytes and an overall LFT panel were calculated against the reference standard of liver disease. Rates of consultations, blood tests, and referrals within 6 months following testing were measured. The 1-year incidence of liver disease in patients with hypertension was 0.5% (95% confidence interval [CI] = 0.4% to 0.6%). Sensitivity and specificity of an LFT panel were modest: 61.3% (95% CI = 53.1% to 69.0%) and 73.8% (95% CI = 73.1% to 74.3%), respectively. The positive predictive value (PPV) of the eight individual LFT analytes were low ranging from 0.2% to 8.9%. Among patients who did not develop liver disease, mean number of consultations, referrals, and tests were higher in the 6 months following false-positives at 10.5, 0.7 and 29.8, respectively, compared with true-negatives: 8.6, 0.6, and 19.8. PPVs of LFTs in primary care were low, with high rates of false-positive results and increased rates of subsequent consultations, referrals, and blood testing. Avoiding LFTs for routine monitoring could potentially reduce patients' anxiety, GP workload, and healthcare costs.

Impact of baseline abnormal liver enzymes in the outcome of COVID-19 infection.

Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation. All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization. A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS. LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.

Severe olanzapine-induced liver function test elevation.

Dear Editor:We read with great interest the case report1 on identifying olanzapine-induced liver injury in the setting of acute hepatitis C. We wanted to bring to the attention of the Mental Health Clinician readers our similar case report entitled “Olanzapine-induced elevated liver function tests in an older person with antidepressant-induced mania”, who similarly experienced significant liver function test (LFT) elevation thought to be related to olanzapine that was published in The Senior Care Pharmacist in September 2022.2Although an increase in LFTs is a known adverse effect of antipsychotics including olanzapine, this is an underappreciated adverse effect, especially as the LFT elevation can be severe. Furthermore, there is no standard of care for monitoring LFTs at baseline or how frequently during antipsychotic treatment LFTs should be monitored.Brelje et al1 cites that olanzapine-induced liver injury has been shown to occur anywhere from 12 days to 8 years after initiating olanzapine, which is similar to what we found in published reports.1,2 In the case that Brelje et al reported, LFT elevation occurred after 6 days of olanzapine therapy and ALT peaked at 1510 IU/L.1 This is similar to the case recently published in The Senior Care Pharmacist of a 67-year-old male where LFT elevation began on day 6 of olanzapine treatment and peaked on day 8 with an AST of 2024 IU/L and ALT of 1508 IU/L.2If drug-induced liver injury or adverse effects of antipsychotics are topics of interest to the reader, we encourage you to read the Brelje et al1 article in the Mental Health Clinician as well as the Reid et al2 article in The Senior Care Pharmacist. The latter article reviews potential mechanisms of olanzapine-induced LFT elevation such as via a toxic intermediary metabolite or in relation to nonalcoholic fatty liver disease.2 Reid et al2 also summarizes 9 additional cases of olanzapine-induced LFT elevation.Brelje et al1 cites “large psychiatric professional societies have refrained from recommending widespread asymptomatic testing”(p213) of hepatic enzymes. However, both articles highlight how significantly elevated LFTs can become within 1 week of starting olanzapine treatment. We encourage readers to incorporate baseline monitoring and consider rechecking within 1 to 2 weeks of initiation with continued monitoring of LFTs in patients treated with antipsychotics including olanzapine into their routine practice.

PMON165 Favorable Liver Safety Profile of the Selective Glucocorticoid Receptor Modulator Relacorilant in Healthy and Hepatically Impaired Adults and in Patients with Cushing Syndrome

Abstract Background Relacorilant is a highly selective glucocorticoid receptor (GR) modulator in development for the treatment of endogenous Cushing syndrome (CS). Unlike the FDA-approved GR antagonist mifepristone, relacorilant lacks affinity for the progesterone and other receptors. In a phase 2 study in patients with CS (NCT02804750, Pivonello et al, 2021), relacorilant provided clinically meaningful changes in a number of cortisol-excess-related comorbidities, including hypertension and hyperglycemia, without undesirable antiprogesterone effects or drug-induced hypokalemia. Currently, 4 clinical studies of relacorilant in patients with CS are ongoing: GRACE (NCT03697109), a phase 3 trial enrolling patients with endogenous CS of all etiologies; GRADIENT (NCT04308590), a phase 3 trial focusing on hypercortisolism due to adrenal adenomas or hyperplasia; a phase 2/3 long-term extension study (NCT03604198); and a phase 1b study in patients with adrenocortical carcinoma associated with glucocorticoid excess (NCT04373265). Here, we report safety results and liver function test (LFT) changes from open-label phase 1 and 2 studies of relacorilant in healthy and hepatically impaired adults and in adult patients with CS. Methods In a special population study, 9 subjects with moderate hepatic impairment (Child-Pugh Class B) and 9 matched controls with normal hepatic function received relacorilant (300 mg QD) for 10 days. In a phase 1 fixed-sequence drug-drug interaction study (NCT03512548), 28 healthy subjects received relacorilant (300 mg QD) for 10 days followed by 10 days of relacorilant (300 mg QD) combined with itraconazole (200 mg QD). Thirty-five patients with CS received relacorilant (100–400 mg QD) for up to 16 weeks in the phase 2 study. Results While relacorilant is eliminated primarily through the hepatic route, no apparent difference in relacorilant pharmacokinetics in subjects with moderate hepatic impairment vs matched controls was observed, with relacorilant exposures (as measured by area under the concentration-time curve [AUC] and maximum concentration [Cmax]) largely overlapping across both groups. In addition, reductions in LFTs were observed in this study. In healthy adults treated with relacorilant followed by relacorilant + itraconazole (an agent with reported liver toxicity), a similar trend toward reduced LFTs was seen throughout the study. In the phase 2 study in patients with CS, reductions in LFTs were also observed, including normalization of LFTs in some patients with abnormal values at baseline. Conclusions These results suggest that relacorilant has a favorable liver safety profile that includes a trend toward improved LFTs in volunteers and patients with normal and abnormal liver function. The findings of the hepatic impairment study support the use of relacorilant without dose adjustment in patients with moderate hepatic impairment. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

The use of Andrographis paniculata and its effects on liver biochemistry of patients with gastrointestinal problems in Thailand during the COVID-19 pandemic: a cross sectional study

In the COVID-19 pandemic, healthcare facility supply and access are limited. There was an announcement promoting Andrographis paniculata (ADG) use for treatment of mild COVID-19 patients in Thailand, but misconception of taking for prevention might occur. Moreover, the effect of ADG on liver function test (LFT) has not been established. To study the ADG use and effect on LFT in patients with gastrointestinal (GI) problems, conducted a cross-sectional study including GI patients who voluntarily filled the ADG questionnaire in Aug–Sep 2021. LFT data at that visit and at the prior visit (if available) were obtained. The changes in LFT within the same person were analyzed and compared between patients with and without ADG consumption. During the study period, a total of 810 patients completed the survey, 168 patients (20.7%) took ADG within the past month. LFT data were available in 485 (59.9%) patients, the median alanine aminotransferase (ALT) change compared with the prior visit was higher in the ADG vs control group (+ 2 vs 0, p = 0.029), and 44.5% had increased ALT (> 3 U/L) vs 32.2% in the ADG and control group, respectively (p = 0.018). Factors independently associated with an increased ALT, from a multivariable logistic regression, were ADG exposure (adjusted OR 1.62, p = 0.042), and patients with NAFLD who gained weight (adjusted OR 2.37, p = 0.046). In conclusion, one-fifth of GI patients recently took ADG, even it is not recommended for COVID-19 prevention. Those who took ADG are more likely to experience an increased ALT than who did not. The potential risk of ADG consumption on liver function should be further assessed.

Hepatobiliary System Effects And Clinical Features of Sars-Cov-2 Infection; Case-Control Study

Introduction: Pandemic caused by SARS-CoV-2 infection has been an important health problem worldwide for the last 3 years. The pathogenesis and consequences of liver injury developed in COVID-19 disease are still unclear. We investigated the prevalence of liver function tests (LFTs) abnormalities in COVID-19 patients, their relationship with drugs, the difference between severe and non-severe COVID-19 patients, and the results of the course of LFTs among patients hospitalized in intensive care units and clinics. Methods: 389 patients who applied to Eskişehir City Hospital between March 2020 and October 2020 were included in the study. Demographic data of RT-PCR (+) patients and RT-PCR (-) control groups (age, gender, comorbidities, symptoms), laboratory parameters, radiological examinations, follow-ups in the clinics and intensive care units, drugs used for the infection were collected retrospectively. All patients with COVID-19 were classified as severe cases or mild to moderate cases groups. Results: Abnormal LFTs were found in 115 (35.2%) of 321 patients with RT-PCR(+), and in 10 (14.7%) of 68 patients in the PCR(-) control group. LFTs at the time of hospitalization were 10.3%, 22.7%, 4.9%, 11.4% and 1.2% in the patient group, respectively; in the control group, it was 1.9%, 2.9%, 2%, 3.3%, 0.8% (p=0.610, p=0.00, p=0.269, p=0.198, p=0.158). There was a significant increase in LFTs in patients who received antibiotics (Levofloxacin, Ceftriaxone, Clarithromycin, Tazobactam, Carbapenem), low molecular weight heparins and antiviral (favipravir) treatments (p=0.001, p=0.001, p=0.001). While the increase in LFTs were significant in the mild (40.2%; 8.2%) and severe groups (41.2%; 5.2%), the number of patients with elevated LFTs in the control group was low (0.5%). Conclusion: Liver damage is common in SARS-CoV-2 infection, but it is quite mild. Patients with severe COVID-19 have a higher frequency of abnormal LFTs than those with mild disease. Disease severity, pre-existing liver disease, and advanced age are risk factors for liver damage. Drug-induced liver injury, systemic inflammatory response syndrome, and hypoxia-induced liver injury may be the main etiological factors for liver injury in COVID-19.

Liver function tests in COVID 19: A retrospective record-based study from a tertiary care centre in urban Maharashtra, India

BackgroundCOVID-19 is a multi system disorder and causes various abnormalities in liver function tests. The aim of this study was to estimate the prevalence of abnormal liver function tests in patients of COVID-19 and to describe the association of liver function tests with clinical features and disease severity in these patients. MethodsWe retrospectively evaluated and analyzed the liver function tests of all real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients admitted to a tertiary care hospital in Western Maharashtra. The Institutional Ethics Committee of our hospital approved the study. ResultsOf the 533 patients included in our study, 50% had abnormal albumin levels while 40.1%, 43.5%, 9.3%, and 6.3% patients had deranged alanine transaminase (ALT) aspartate transaminase (AST), total protein and bilirubin levels, respectively. Hepatocellular injury was observed in 21 (3.9%) patients, and cholestatic liver injury was observed in seven (1.3%) patients. Abnormal liver function test (LFT) was significantly associated with disease severity but not with mortality. ConclusionAbnormal LFT in patients of COVID-19 is associated with severe disease but not mortality. Liver injury is common in patients of COVID-19.

Change in liverfunction tests in patients switched form olive oil based tpn to fish oil containing tpn

Rationale: The Nutritional Support Team of the University Medical Center Groningen ( UMCG ) (consisting of dieticians, registered nurses, nurse practitioners and gastroenterologists) coordinates and monitors an increasing number of adult patients with home Total Parenteral Nutrition (TPN) for mainly type 2 intestinal failure. These patients are initially all treated with olive oil based parenteral nutrition (Olimel N9E, Baxter). When during TPN treatment patients develop signs of liver dysfunction, we change into a fish oil containing TPN (SmofKabiven, Fresenius Kabi). In this study we investigated the course of the liver tests in these patients.

Severe COVID-19 Associated With Liver Injury in Patients Without Preexisting Liver Disease.

Objective: Coronavirus disease 2019 (COVID-19) is known to disturb liver function tests (LFTs). Not much literature is available regarding the effect of COVID-19 on LFTs in patients without preexisting liver disease. The study aimed to find the effect of COVID-19 in these patients.Methods: This was a single-center, observational study with 142 patients who were admitted with COVID-19 during three months. Seven patients were excluded due to the presence of chronic liver disease. Results: A total of 135 patients were included in the study aged between 18 and 95 years (mean 57.7 ± 15.6); among them, 93 were males (68.9%). Hypertension was present in 74 patients (54.8%), and diabetes was present in 48 patients (35.6%). Fever was the chief complaint in 112 patients (83%), followed by dyspnea in 93 patients (68.9%) and cough in 79 patients (58.5%). Elevated aspartate aminotransferase (AST) was seen in 35 patients (26%), gamma-glutamyl transferase (GGT) in 43 patients (32%), alanine transaminase (ALT) in 18 patients (24%), alkaline phosphatase in 19 patients (14%), bilirubin in six patients (4%), and low albumin in 27 patients (20%). Severe COVID-19, when compared with mild to moderate disease, was associated with elevated AST > two-time upper limit normal (2ULN) (p = 0.002), GGT > 2ULN (0.026), and lower albumin (p = 0.020), higher systemic inflammatory response syndrome (SIRS) (0.045), raised procalcitonin (p = 0.045), higher ferritin (p = 0.005), lower pO2 (p = 0.044), and higher Sequential Organ Failure Assessment score (SOFA) (p = 0.002) pointing to the inflammatory response as cause of liver injury. Factors predicting mortality with COVID-19 were assessed, which showed that direct bilirubin (p = 0.001), low albumin (p = 0.013), tachypnea (0.002), and leukocytosis (<0.001) were independently associated with increased COVID-19-related mortality.Conclusion: Patients suffering from COVID-19 have evidence of liver injury, which appears to be secondary to an inflammatory response that correlates with the severity of COVID-19.

S2478 A Case Series of Four Patients and Elevated Transaminases Associated With Acute COVID-19 Infection

INTRODUCTION: Recent studies have suggested that COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20), can cause abnormal liver function tests (LFT) in affected patients both with and without pre-existing liver disease. Here we describe a series of patient cases involving abnormal LFTs in patients with confirmed COVID-19 infections in both the inpatient and outpatient setting at the Mayo Clinic in Florida. CASE DESCRIPTION/METHODS: 4 cases of COVID-19 infection with concomitant abnormal LFTs were identified. Only 1 of the 4 patients required hospital admission while three other patients were managed on an outpatient basis. 1 patient was managed completely outpatient, 2 patients required an emergency department visit, and the last patient was hospitalized and admitted to the ICU. 3/4 patients had no pre-existing liver conditions, while 1 patient had findings suggestive of nonalcoholic fatty liver disease (NAFLD) on imaging with no prior diagnosis. Only 2 out of 4 patients had gastrointestinal symptoms including nausea, abdominal pain, and diarrhea. All patients recovered from COVID-19 with no major sequelae and their LFTs returned to baseline levels with no major intervention. 2 out of 4 patients were given hydroxychloroquine as part of their treatment. The average max aspartate transaminase (AST) and alanine transaminase (ALT) among all patients were 206 ± 58.7 and 313 ± 155, respectively. No significant pattern was seen between elevations of AST vs ALT. Notably, all patients had abnormal AST and ALT, but only 1 patient had elevated ALP. Bilirubin was not affected in all patients. DISCUSSION: In the literature, there have been reports of abnormal liver function tests associated with SARS-CoV2. In many of these reports, only a small subset of patients had pre-existing liver conditions (< 10%). This suggests that there are unknown variables involved in COVID-19 infection that leads to liver injury. Severe illness leading to shock, hypoxia, or inflammation can all affect the liver, independently of the SARS-CoV-2 virus. Only one patient in the series was hospitalized, and all patients recovered from their disease over the course of 2 weeks. Other possible mechanisms include direct damage of liver cells by the virus or treatment associated drug hepatoxicity. Further studies are needed to evaluate the association between liver injury and the SARS-CoV-2 virus.

Using 99mTc-DTPA galactosyl human serum albumin liver scintigraphy as a prognostic indicator in jaundice-free patients with biliary atresia

BackgroundWe evaluated the clinical significance of follow-up data, including 99mTc-DTPA galactosyl human serum albumin (99mTc-GSA) liver scintigraphy data, as prognostic indicators for jaundice-free patients with biliary atresia (BA). MethodsOf 87 patients who underwent Kasai portoenterostomy (KP) between 1991 and 2012, 45 jaundice-free patients aged 1–2 years underwent 99mTc-GSA scintigraphy and were classified into 2 groups: those who survived with a native liver (Group A, n = 34) and those who required liver transplantation (LTx) (Group B, n = 11). We compared 99mTc-GSA scintigraphy data (HH15, LHL15, and HH15/LHL15 [H/L15]) and liver function test (LFT) results between the groups. The patients underwent a second 99mTc-GSA scintigraphy at approximately 5 years of age. ResultsAll patients survived. HH15, H/L15, total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, and alanine transaminase levels were higher in Group B than in Group A (p<0.05). Total and direct bilirubin levels were associated with H/L15 (p<0.05). There were no significant changes in results between the first and second 99mTc-GSA scintigraphy in Group A. ConclusionsMid- and long-term prognoses may be predicted using 99mTc-GSA scintigraphy data and LFTs in patients aged 1–2 years. We recommend regular monitoring of postoperative data following KP, even in jaundice-free patients. Level of evidenceIII.

Liver Function Test Abnormalities in Depressed Patients Treated with Antidepressants: A Real-World Systematic Observational Study in Psychiatric Settings

BackgroundConcerning the risk of antidepressant induced liver injury, it is not clear whether psychiatrists perform a liver function test (LFT) and whether an increase in aminotransferase levels should contraindicate antidepressant treatment.AimTo evaluate LFT availability, the prevalence of LFT abnormalities and the probable cause of an altered LFT in patients with a major depressive episode (MDE) requiring an antidepressant drug.MethodsWe studied LFT evaluation in a real world psychiatric setting, in a sample of 321 consecutive patients with a current major depressive episode (MDE) requiring an antidepressant drug treatment, but without current alcohol or drug dependence or unstable medical disease.ResultsAn LFT is performed in 36.1% (116/321) of depressed patients. One fifth of antidepressant-treated patients who had an LFT evaluation had abnormal results. The most frequent causes of LFT abnormalities were: NAFLD (nonalcoholic fatty liver disease) (7/321; 2.1%), acute alcohol consumption (4/321; 1.2%), antidepressant-induced liver injury (3/321; 0.9%), hepatitis C virus infection (2/321; 0.6%) and heart failure (1/321; 0.3%). The cause of LFT abnormalities was unknown in 32% of patients (8/25) due to the absence of etiological investigations.ConclusionThese results demonstrate that an LFT is infrequently performed by psychiatrists in depressed patients requiring an antidepressant drug. Baseline LFT assessment and observations during the first six months of antidepressant treatment may be useful for detection of patients with pre-existing liver disease such as NAFLD, and early identification of cases of antidepressant-induced liver injury. An increase in aminotransferase levels may be related to an underlying liver disease, but does not contraindicate antidepressant treatment.

Liver Function Test Abnormalities in Patients with Inflammatory Bowel Diseases: A Hospital-based Survey.

BACKGROUND AND AIMSInflammatory bowel diseases (IBD) are frequently associated with altered liver function tests (LFTs). The causal relationship between abnormal LFTs and IBD is unclear. The aim of our study was to evaluate the prevalence and etiology of LFTs abnormalities and their association with clinical variables in a cohort of IBD patients followed up in a single center.MATERIALS AND METHODSA retrospective review was undertaken of all consecutive IBD in- and outpatients routinely followed up at a single referral center. Clinical and demographic parameters were recorded. Subjects were excluded if they had a previous diagnosis of chronic liver disease. LFT abnormality was defined as an increase in aspartate aminotransferase, (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), or total bilirubin.RESULTSA cohort of 335 patients (179 males, mean age 46.0 ± 15.6 years) was analyzed. Abnormal LFTs were detected in 70 patients (20.9%). In most cases, the alterations were mild and spontaneously returned to normal values in about 60% of patients. Patients with abnormal LFTs were less frequently on treatment with aminosalicylates (22.8 vs. 36.6%, P = 0.04). The most frequent cause for transient abnormal LFTs was drug-induced cholestasis (34.1%), whereas fatty liver was the most frequent cause of persistent liver damage (65.4%). A cholestatic pattern was found in 60.0% of patients and was mainly related to older age, longer duration of disease, and hypertension.CONCLUSIONSThe prevalence of LFT abnormalities is relatively high in IBD patients, but the development of severe liver injury is exceptional. Moreover, most alterations of LFTs are mild and spontaneously return to normal values. Drug-induced hepatotoxicity and fatty liver are the most relevant causes of abnormal LFTs in patients with IBD.

Association of serum glutamic pyruvic transaminase and non-alcoholic fatty liver disease in controlled and uncontrolled diabetes

Introduction: The liver has been recognised as a major target of injury in patients with insulin resistance or metabolic syndrome. Non-alcoholic fatty liver disease is characterised by accumulation of hepatic fat in the absence of significant alcohol intake. Serum glutamic pyruvic transaminase (SGPT) appears to have a role in gluconeogenesis and seems to be more related to hepatic fat accumulation than serum glutamic oxaloacetic transaminase (SGOT). Materials and Methods: One-hundred previously diagnosed patients of controlled (HbA1c 7%) diabetes with fatty liver, diagnosed by ultrasound, were taken and their liver function test (LFT) plus glycated haemoglobin were estimated. One-hundred diagnosed cases of controlled and uncontrolled diabetes without fatty liver and normal controls were taken and LFT was done. Result and Discussion: Serum bilirubin, serum albumin, and alkaline phosphatase were within normal range in all the diabetic cases and control. The SGOT was not significantly raised in diabetics. The SGPT was raised in diabetics without fatty liver as compared to normal controls, but not significantly raised and was within normal limits. However, the SGPT was raised significantly in diabetics with fatty liver (P Conclusion: Non-alcoholic fatty liver disease has been consistently associated with insulin resistance and hyperinsulinaemia. This has raised a concern that treatment with insulin in type 2 diabetes may aggravate liver disease. Routine monitoring of LFTs in patients with type 2 diabetes should be done at the start of drug therapy and in patients if symptoms develop raising concern about hepatic impairment.

SAT0366 Absence of Impact of Febuxostat Treatment in Patients with Gout with and Without Altered Fiver Function Tests

BackgroundPatients with altered liver function test (LFTs) do not qualify to enter into clinical trials for registration purposes. Therefore, scarce data are available for patients with altered liver function test...

Cystic fibrosis, elevated gamma-glutamyltransferase, and lung transplant outcome

Dear Sirs,In their study recently published in this journal [1], Wreeet al. have investigated the prognostic impact of liverfunction tests in patients with end-stage cystic fibrosis(CF) undergoing double lung transplant (DLTx). Theauthors’ focus was put on CF-associated liver injury asfactor possibly affecting the outcome of surgery even inabsence of overt signs of liver cirrhosis, such as portalhypertension. In a cohort of 31 cases with median follow-up of 1000 days, preoperatively elevated gamma-glutamyl-transferase (GGT) was identified to be associated withhigher mortality following DLTx. Postoperatively elevatedGGT was also associated with higher mortality, accompa-nied in this case by elevated bilirubin. Thus, the impor-tance of close monitoring of liver function in CFcandidates to DLTx is underscored [1].We would like to call the attention on a possiblealternative explanation for elevated serum GGT levels inCF patients. Despite the well-known and establishedrole of GGT as a marker of liver and biliary disease,the significance of this enzyme activity in fact hasrecently expanded to include several additional aspects,e.g., in tumor biology [2] and atherosclerosis [3]. Asfar as CF is concerned, GGT is known to increaseseveral fold in the lung lining fluid of CF patients [4].In CF sputum specimens, we have recently identifiedactivated neutrophilic granulocytes as the source ofGGT increase; neutrophils in fact contain GGT in theirspecific granules and can release it upon activation [5].Identification of the neutrophilic origin of increasedGGT was achieved by means of chromatographic tech-niques allowing to separate and compare distinctGGT-containing protein fractions deriving from differ-ent cellular sources [6].It has been suggested that CF neutrophils may havean increased propensity to release their granule proteins,because of increased secretion of cytokines and/or stillunknown priming mechanisms [7]. It would be ofinterest to verify whether the increased serum GGTobserved by Wree et al. might also derive from hyper-reactivity of peripheral blood neutrophils in selectedpatients. Rather than referring to underlying conditionsof liver dysfunction, the less favorable outcome of DLTxin these subjects could point then to a ‘‘hyperinflamma-tory’’ status [8], which could prompt the devisement ofmore specific pre- and/or postoperative therapeuticstrategies.Alessandro Corti,

A case highlighting antituberculosis drug induced hepatotoxicity

Objective/BackgroundA reasonable incidence of tuberculosis (TB) still occurs in the United Kingdom with around 9000 cases reported each year. In 2008 415 of these cases occurred in the 15–19 year...

Risk Factors for Abnormal Liver Function Tests in Patients With Ileal Pouch–Anal Anastomosis for Underlying Inflammatory Bowel Disease

Liver involvement is common in patients with inflammatory bowel disease (IBD). However, the frequency and the significance of liver function test (LFT) abnormalities in patients with ileal pouch-anal anastomosis (IPAA) for underlying IBD have not been studied. The aim of this study was to evaluate the prevalence and to identify risk factors for abnormal LFTs in patients with IPAA and underlying IBD. All patients were identified from our prospectively maintained Pouchitis Database between 2002 and 2008. Abnormal LFTs were classified as the following: (i) any abnormal elevation of transaminases, and/or alkaline phosphatase (ALP), and/or bilirubin; (ii) hepatitis, if there was more than twice the elevation of transaminases; and (iii) cholestatic, if there was more than 1.5 times elevation of ALP. Clinical, endoscopic, and histological variables were assessed using Cox proportional hazard models for evaluating risk for abnormal LFTs. A total of 545 IPAA patients with underlying IBD were identified from the database, of which 373 patients who had LFTs done after their pouch surgery were included. This included 346 patients with ulcerative colitis, 25 with indeterminate colitis, and 2 with Crohn's colitis before surgery. Their mean age was 45.9+/-13.8 years. A total of 65 patients (17.4%) (40 men, 25 women, median age: 47 years) had abnormal LFTs. Of the patients, 52 (13.9%) had abnormal transaminases, whereas 15 (4%) were classified as having hepatitis. Thirty-five (9.4%) patients had an abnormal ALP level, with 18 (4.8%) classified as cholestatic. The most common cause of an abnormal LFT was transient elevation in 32 (49.2%) patients, followed by fatty liver (fatty change on imaging with body mass index (BMI) > or =25 kg/m(2) in the absence of other causes, including alcohol abuse and drug-induced hepatitis) in 10 (15.4%), drug-induced abnormal LFTs in 7 (10.7%), and chronic hepatitis B or C in 6 (9.2%). Primary sclerosing cholangitis (PSC) was responsible for abnormal LFTs in 10 patients (15.4%). Cox proportional hazard model analysis showed that BMI (hazard ratio (HR)=1.07, 95% confidence interval (95% CI): 1.02, 1.12; P=0.003), the presence of PSC (HR=4.49, 95% CI: 1.45, 13.89; P=0.009), autoimmune disorder (HR=2.54, 95% CI: 1.09, 5.93; P=0.031), a family history of IBD (HR=2.32, 95% CI: 1.29, 4.17; P=0.005), and extensive colitis before colectomy (HR=4.59, 95% CI: 2.04, 10.33; P<0.001) predicted any abnormal LFTs. Abnormal LFTs were common in patients with IPAA in this cohort. The presence of co-existing autoimmune disorder, a family history of IBD, extensive colitis before colectomy, the presence of PSC, and a high BMI appear to be a significant risk factors for abnormal LFTs. Whether abnormal LFTs affect health-related quality of life, pouch survival, and selection of pouch-related medical therapy requires further investigation.

Obstetric cholestasis with elevated gamma glutamyl transpeptidase: incidence, presentation and treatment.

Obstetric cholestasis (OC) may cause severe pruritus in the mother and lead to fetal distress and stillbirth. The etiology of OC is multifactorial, but includes inherited dysfunction of bile canalicular transporters. One of these, multidrug resistant protein 3 (MDR3), a phospholipid transporter, when dysfunctional is associated with elevated levels of gamma glutamyl transpeptidase (GGT). The aim of the present study was to assess the incidence of OC associated with elevated GGT. We compared the natural history of a cholestatic pregnancy and the efficacy of ursodeoxycholic acid (URSO) in OC patients grouped according to a normal or raised GGT level. Eighty-one patients with OC were analyzed. OC was diagnosed in patients with pruritus and elevated serum bile acids (SBA). Fifty-seven consenting volunteer patients (70%) were treated with URSO. Elevated GGT at presentation was found in 21 patients (30%) and was associated with significantly higher serum levels of aspartate transaminase (AST), bilirubin (BIL) and SBA. OC presented at approximately the same gestation week in both groups of patients. In patients not treated with URSO, liver function tests (LFT) showed no significant change from the time of diagnosis to delivery. Patients from both groups responded to URSO with significant improvement in their AST and alanine aminotransferase (ALT) levels, but SBA fell significantly only in the normal GGT group. An elevated GGT occurs in less than one-third of patients with OC in the UK and, when present, is associated with greater impairment of LFT, but no difference in gestational age at onset. Treatment with URSO appears to be safe and significantly improves LFT in patients with OC, with the exception of SBA in the high GGT group.