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Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

BACKGROUND: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performe...

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Autores principales: Shrestha, Anup, Neupane, Harish Chandra, Tamrakar, Kishor Kumar, Bhattarai, Abhishek, Katwal, Gaurav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814543/
https://www.ncbi.nlm.nih.gov/pubmed/33468067
http://dx.doi.org/10.1186/s12245-021-00332-1
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author Shrestha, Anup
Neupane, Harish Chandra
Tamrakar, Kishor Kumar
Bhattarai, Abhishek
Katwal, Gaurav
author_facet Shrestha, Anup
Neupane, Harish Chandra
Tamrakar, Kishor Kumar
Bhattarai, Abhishek
Katwal, Gaurav
author_sort Shrestha, Anup
collection PubMed
description BACKGROUND: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. METHOD: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT. RESULTS: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86–0.98) and of ALT was 0.92 (95% confidence interval 0.83–0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively. CONCLUSION: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-021-00332-1.
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spelling pubmed-78145432021-01-19 Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury Shrestha, Anup Neupane, Harish Chandra Tamrakar, Kishor Kumar Bhattarai, Abhishek Katwal, Gaurav Int J Emerg Med Original Research BACKGROUND: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. METHOD: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT. RESULTS: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86–0.98) and of ALT was 0.92 (95% confidence interval 0.83–0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively. CONCLUSION: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-021-00332-1. Springer Berlin Heidelberg 2021-01-19 /pmc/articles/PMC7814543/ /pubmed/33468067 http://dx.doi.org/10.1186/s12245-021-00332-1 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
Shrestha, Anup
Neupane, Harish Chandra
Tamrakar, Kishor Kumar
Bhattarai, Abhishek
Katwal, Gaurav
Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title_full Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title_fullStr Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title_full_unstemmed Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title_short Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
title_sort role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814543/
https://www.ncbi.nlm.nih.gov/pubmed/33468067
http://dx.doi.org/10.1186/s12245-021-00332-1
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