DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172429

Evaluating the role of liver enzymes as predictors of severity of liver injury in patients with blunt abdominal trauma

Preetha Prasad, Abhijith Acharya, Gopi Ellikunnel Vithon, Girish N. M. Kumar

Abstract


Background: Liver is the 2nd most common organ affected in patients with blunt abdominal trauma (BAT). Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, a challenge exists in centers devoid of CT scan, where an elevation in hepatic transaminases may provide guidance for the emergency physician in seeking further imaging and/or surgical consultation.

Methods: In patients with suspected BAT blood samples were taken for estimation of liver enzymes (AST and ALT). All patients underwent contrast enhanced CT of the abdomen. Hemodynamically unstable patients were taken up for laparotomy and the findings were recorded. Based on imaging / surgery patients were subdivided into 2 groups (with and without liver injury). Liver injuries were graded according to organ injury scale by American Association of Surgery for Trauma.

Results: ALT>100 units had 100% sensitivity and specificity improved to 83.78%. The mean level of ALT in patients without liver injury was around 64. This increased to 142 in grade 1 and upto 780 units in grade 4 injury. The same rising trend was seen when AST was evaluated against grade of Liver injury. This was statistically significant (p<0.01).

Conclusions: ALT is the better of the transaminases in predicting liver injury. The rise in transaminases is directly proportional to grade of liver injury.


Keywords


BAT, Liver enzymes

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References


Carrillo EH, Wohltmann C, Richardson JD, Polk HC. Evolution in the treatment of complex blunt liver injuries. Current problems in surgery. 2001;38(1):A3-60.

Marx JA. Rosen’s emergency medicine: concepts and clinical practice. 5th ed. St. Louis: Mosby; 2002:415-420.

Moore EE, Cogbill TH, Jurkovich GJ. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323-4.

Kirkpatrick AW, Sirois M, Laupland KB. Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. Can J Surg. 2005;48:453-60.

Richards JR, McGahan JP, Pali MJ. Sonographic detection of blunt hepatic trauma: hemoperitoneum and parenchymal patterns of injury. J Trauma. 1999;47:1092-7.

Piper GL, Peitzman AB. Current management of hepatic trauma. Surg Clin North Am. 2010;90:775.

Richards JR, Derlet RW. Computed tomography for blunt abdominal trauma in the ED: a prospective study. Am J Emerg Med. 1999;16:338-42.

Kreimeyer S, Grenacher L. Modern imaging techniques for liver trauma. Chirurg. 2009;80:896.

Puranik S, Hayes J, Long J. Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. South Med J. 2002;95:203-6.

Stassen NA, Lukan JK, Carrillo EH, Spain DA, Norfleet LA, Miller FB, et al. Examination of the role of abdominal computed tomography in the evaluation of victims of trauma with increased aspartate aminotransferase in the era of focused abdominal sonography for trauma. Surgery. 2002;132(4):642-7.

Knudson M, Maull K. Nonoperative management of solid organ injuries. Surg Clin North Am. 1999;79:1357-71.

Pachter H, Knudson M, Esrig B. Status of nonoperative man- agement of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996;40:31-8.

Richardson J, Franklin G, Lukan J. Evolution in management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232:324-30.

Oldham K, Guice K, Kaufman R. Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children. J Pediatr Surg 1984;19:457-61.

Hennes HM, Smith DS, Schneider K, Hegenbarth MA, Duma MA, Jona JZ. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics. 1990;86(1):87-90.

Sahdev P, Garramone R, Schwartz R. Evaluation of liver function tests in screening for intra-abdominal injuries. Ann Emerg Med. 1991;20:838-41.

Srivastava AR, Kumar S, Agarwal GG, Ranjan P. Blunt abdominal injury: serum ALT—a marker of liver injury and a guide to assessment of its severity. Injury. 2007;38(9):1069-74.

Tian Z, Liu H, Su X, Fang Z, Dong Z, Yu C, Luo K. Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma. Exp Therap med. 2012;4(2):255-60.