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‘Liver function tests’ on the intensive care unit: a prospective, observational study

Intensive Care Medicine volume 35, pages 1406–1411 (2009)Cite this article

Abstract

Aims

To evaluate the prevalence, patterns and significance of deranged liver function tests (LFT) in critically ill patients.

Methods

A prospective, observational data collection of the LFT [bilirubin, alanine aminotransferase (ALT), alkaline phosphatase (AKP), gamma glutaryl transferase (γGT)] and critical care parameters in all admissions to the general intensive care unit (ICU) of our institution. Prevalence of abnormal LFT on the day of ITU admission is described and the relationship of abnormal LFT to clinical events and 30-day mortality analysed.

Results

Of 263 first admissions without hepatobiliary disease, 61% demonstrated an abnormal LFT at the point of admission. The majority of abnormalities were less than twice the upper limit of normal. Episodes of ventilation, haemofiltration and hypotension during the first 48 h were associated with an abnormal ALT on day 3. The presence of an abnormal ALT [odds ratio 2.7 (1.2–6.0)], AKP [OR 2.8 (1.1–7.3)] or γGT [OR 3.9 (1.9–8.3)] was associated with an increased risk of death within 30 days of admission. When adjusted for APACHE II score, LFTs were not independent predictors of mortality.

Discussion

Low-grade abnormalities of LFT are a significant entity in critically ill patients and show an association with mortality outcomes and clinical events on ICU. They are likely to represent part of a spectrum of liver injury associated with critical illness and should not be disregarded.

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References

  1. Thomson SJ et al (2008) British Society of Gastroenterology abstracts 2008. Gut 57 Suppl 1:A85

  2. Birrer R, Takuda Y, Takara T (2007) Hypoxic hepatopathy: pathophysiology and prognosis. Intern Med 46:1063–1070

    PubMed  Article  Google Scholar 

  3. Chand N, Sanyal AJ (2007) Sepsis-induced cholestasis. Hepatology 45:230–241

    PubMed  Article  CAS  Google Scholar 

  4. Lee WM (2003) Drug-induced hepatotoxicity. N Engl J Med 349:474–485

    PubMed  Article  CAS  Google Scholar 

  5. Brienza N, Dalfino L, Cinnella G, Diele C, Bruno F, Fiore T (2006) Jaundice in critical illness: promoting factors of a concealed reality. Intensive Care Med 32:267–274

    PubMed  Article  Google Scholar 

  6. Kramer L, Jordan B, Druml W, Bauer P, Metnitz PG (2007) Incidence and prognosis of early hepatic dysfunction in critically ill patients—a prospective multicenter study. Crit Care Med 35:1099–1104

    PubMed  Article  Google Scholar 

  7. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    PubMed  Article  CAS  Google Scholar 

  8. Case Mix Programme Database ICNAaRCI, Tavistock House, Tavistock Square, London WC1H 9HR (2008)

  9. Seeto RK, Fenn B, Rockey DC (2000) Ischemic hepatitis: clinical presentation and pathogenesis. Am J Med 109:109–113

    PubMed  Article  CAS  Google Scholar 

  10. Koskinas J, Gomatos IP, Tiniakos DG, Memos N, Boutsikou M, Garatzioti A, Archimandritis A, Betrosian A (2008) Liver histology in ICU patients dying from sepsis: a clinico-pathological study. World J Gastroenterol 14:1389–1393

    PubMed  Article  CAS  Google Scholar 

  11. Jinks MF, Kelly CA (2004) The pattern and significance of abnormal liver function tests in community-acquired pneumonia. Eur J Intern Med 15:436–440

    PubMed  Article  Google Scholar 

  12. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    PubMed  Article  CAS  Google Scholar 

  13. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    PubMed  Article  CAS  Google Scholar 

  14. Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I (2004) Normal serum aminotransferase concentration and risk of mortality from liver diseases prospective cohort study. BMJ 328:983

    PubMed  Article  CAS  Google Scholar 

  15. Ioannou GN, Weiss NS, Boyko EJ, Mozaffarian D, Lee SP (2006) Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States. Hepatology 43:1145–1151

    PubMed  Article  CAS  Google Scholar 

  16. Kim WR, Flamm SL, Di Bisceglie AM, Bodenheimer HC (2008) Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease. Hepatology 47:1363–1370

    PubMed  Article  CAS  Google Scholar 

  17. Kazemi-Shirazi L, Endler G, Winkler S, Schickbauer T, Wagner O, Marsik C (2007) Gamma glutamyltransferase and long-term survival: is it just the liver? Clin Chem 53:940–946

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

SJT is supported by a fellowship grant from the St George’s Hospital Charity. MLC is the holder of a research development award from the National Institute of Healthcare Research.

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Affiliations

  1. Department of Gastroenterology and Hepatology, St George’s Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, UK

    S. J. Thomson, M. L. Cowan, I. Johnston, S. Musa & T. M. Rahman

  2. Department of Intensive Care Medicine, St George’s Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, UK

    S. J. Thomson, I. Johnston, S. Musa, M. Grounds & T. M. Rahman

Authors
  1. S. J. Thomson
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  2. M. L. Cowan
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  3. I. Johnston
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  4. S. Musa
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  5. M. Grounds
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  6. T. M. Rahman
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Corresponding author

Correspondence to T. M. Rahman.

Additional information

MLC is the holder of a Research Development Award from the National Institute of Healthcare Research.

The author(s) declare that they have no competing interests.

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Thomson, S.J., Cowan, M.L., Johnston, I. et al. ‘Liver function tests’ on the intensive care unit: a prospective, observational study. Intensive Care Med 35, 1406–1411 (2009). https://doi.org/10.1007/s00134-009-1511-7

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  • DOI: https://doi.org/10.1007/s00134-009-1511-7

Keywords

  • Liver function test
  • Critical care
  • Bilirubin
  • Alanine transaminase
  • Alkaline phosphatase
  • Gamma glutaryl transferase