DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201935

Jaundice in adult patients above 50 years of age: a comparative study of liver function tests

Suneel Chauhan, Vijay Kumar Barwal, Gopal A. Sharma, Ajay Vaid, Nikhil Sood, Naveen Rana

Abstract


Background: Diagnosis of jaundice involves a range of tests. The liver function tests are done in all to arrive at a diagnosis and then manage the case appropriately. With advancing age, the incidence of liver disease increases. Understanding these changes is important for the management of liver diseases in the elderly. We conducted this study to find the difference in mean levels of Liver enzymes in younger and older age group of patients suffering with jaundice.

Methods: It was a prospective observational study. All patients admitted with jaundice in the medicine ward satisfying inclusion/exclusion criteria were enrolled. The results of liver function tests in younger age and older age participants were then compared.

Results: Total 100 participants were enrolled during the study period. 53 were enrolled in group one and the rest in group two. Anorexia (90%) was the most common symptom followed by abdominal distension (54%). The total bilirubin (8.8±4.7) as well as conjugated bilirubin (3.4±2.8) were higher in group one though they were not significant statistically (p=0.10 and 0.25 respectively). Mean AST and ALT levels were much higher in group 1 and statistically significant (p values <0.004 and 0.002 respectively). Conversely the mean PT values were higher in group two (p=0.02).

Conclusions: Although the symptom severity may be more in elderly, the LFTs are not deranged proportionately. So there is a need to devise separate cut offs and these have to be lower for the older age group patients with jaundice. More studies with larger sample size are required to confirm the results.


Keywords


Adult patients, Comparative study, Jaundice, Liver function tests

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References


Sherlock S. Dubey J. Diseases of Liver and Biliary system. 11th ed. Cholestatsis. London: Blackwell science; 2001: 223.

Chopra S, Griffin PH. Laboratory tests and diagnostic procedures in evaluation of liver disease. Am J Medi. 1985 Aug 1;79(2):221-30.

Schenker S, Balint J, Schiff L. Differential diagnosis of jaundice: report of a prospective study of 61 proved cases. Am J Digest Dis. 1962 May 1;7(5):449-63.

O'Connor KW, Snodgrass PJ, Swonder JE, Mahoney S, Burt R, Cockerill EM, et al. A blinded prospective study comparing four current noninvasive approaches in the differential diagnosis of medical versus surgical jaundice. Gastroenterology. 1983 Jun 1;84(6):1498-504.

Schmucker DL. Age-related changes in liver structure and function: implications for disease?. Experim Gerontol. 2005 Aug 1;40(8-9):650-9.

Chacko RT, Chacko A. Serum & muscle magnesium in Indians with cirrhosis of liver. Indian J Medi Res. 1997 Nov 1;106:469-74.

Sarin SK, Dhingra N, Bansal A, Malhotra S, Guptan R. Dietary and nutritional abnormalities in alcoholic liver disease: a comparison with chronic alcoholics without liver disease. Am J Gastroenterol. 1997 May 1;92(5).

Maskey R, Karki P, Ahmed SV, Manandhar DN. Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal. Nepal Med Coll J. 2011 Jun;13(2):115-8.

Suthar H, Suthar K, Mewada B. Clinical profile of cases of alcoholic liver disease. Int J Med Sci Public Health. 2013 Apr 1;2(2):408-12.

Pathak OK, Paudel R, Panta OB, Pant HP, Giri BR, Adhikari B. Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in Western Nepal. Saudi J Gastroenterol: Offi J Saudi Gastroenterol Assoc. 2009 Jul;15(3):171.

Ahsan T, Ahsan M, Kamal MM, Hossain KJ, Haque ME, Islam SN. Lifestyle, nutritional status and seroclinical profile of liver cirrhotic patients. Banglad Medi J. 2007;36(2):44-7.

Hajiani E, Hashemi S, Masjedizadeh R, Ahmadzadeh S. Liver cirrhosis seen in GI clinics of Ahvaz, Iran. Govaresh. 2012 Oct 3;17(3):178-82.

Bustíos C, Dávalos M, Román R, Zumaeta E. Clinical and epidemiological profile of cirrhosis in the liver unit at Edgardo Rebagliati Martins National Hospital. Rev Gastroenterol Del Peru: Organo Ofi La Soc Gastroenterol Del Peru. 2007;27(3):238-45.

Deetman PE, Alkhalaf A, Landman GW, Groenier KH, Kootstra‐Ros JE, et al. Alanine aminotransferase and mortality in patients with type 2 diabetes (ZODIAC‐38). Eur J Clini Investig. 2015 Aug;45(8):807-14.

Dong MH, Bettencourt R, Brenner DA, Barrett-Connor E, Loomba R. Serum levels of alanine aminotransferase decrease with age in longitudinal analysis. Clini Gastroenterol Hepatol. 2012 Mar 1;10(3):285-90.

Kim H, Kisseleva T, Brenner DA. Aging and liver disease. Curr Opini Gastroenterol. 2015 May;31(3):184.

Tietz NW, Shuey DF, Wekstein DR. Laboratory values in fit aging individuals-sexagenarians through centenarians. Clini Chem. 1992 Jun 1;38(6):1167-85.

Dong MH, Bettencourt R, Barrett-Connor E, Loomba R. Alanine aminotransferase decreases with age: the Rancho Bernardo Study. PloS One. 2010;5(12).

Roche SP, Kobos R. Jaundice in the adult patient. Am Family Physici. 2004 Jan 15;69(2):299-304.

Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Family Physici. 2017 Feb 1;95(3):164-8.

Shah AA, Patton M, Chishty WH, Hussain A. Analysis of elevated liver enzymes in an acute medical setting: Jaundice may indicate increased survival in elderly patients with bacterial sepsis. Saudi J Gastroenterology: Offi J Saudi Gastroenterol Assoc. 2010 Oct;16(4):260-3.

Premoli A, Paschetta E, Hvalryg M, Spandre M, Bo S, Durazzo M. Characteristics of liver diseases in the elderly: a review. Minerva Gastroenterol E Dietol. 2009 Mar;55(1):71-8.

Boland BS, Dong MH, Bettencourt R, Barrett-Connor E, Loomba R. Association of serum bilirubin with aging and mortality. J Clini Experim Hepatol. 2014 Mar 1;4(1):1-7.

Neki NS. Jaundice In Elderly. JK Scie. 2013 Jul 1;15(3):113-6.