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Review Article| Volume 27, ISSUE 1, P1-16, February 2023

Evaluation of the Patient with Markedly Abnormal Liver Enzymes

Published:October 17, 2022DOI:https://doi.org/10.1016/j.cld.2022.08.007

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      References

        • Sookoian S.
        • Pirola C.J.
        Liver enzymes, metabolomics and genome-wide association studies: from systems biology to the personalized medicine.
        World J Gastroenterol. 2015; 21: 711-725
        • Rej R.
        Aminotransferases in disease.
        Clin Lab Med. 1989; 9: 667-687
        • Horiuchi S.
        • Kamimoto Y.
        • Morino Y.
        Hepatic clearance of rate liver aspartate aminotransferase isoenzymes: evidence for endocytotic uptake via different binding sites on sinusoidal liver cells.
        Hepatol. 1985; 5: 376-382
        • Smit M.J.
        • Wijnholds J.
        • Duursma A.M.
        • et al.
        Plasma clearance of mitochondrial aspartate aminotransferase in the rate: competition with mitochondrial malate dehydrogenase.
        Biomed Biochim Acta. 1986; 45: 1557-1561
        • Wieme R.J.
        • Demeulenaere L.
        Enzyme assays in liver disease.
        J Clin Pathol Suppl (Assoc Clin Pathol). 1970; 4: 51-59
        • Ioannou G.N.
        • Weiss N.S.
        • Boyko E.J.
        • et al.
        Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States.
        Hepatol. 2006; 43: 1145-1151
        • Prati D.
        • Taioli E.
        • Zanella A.
        • et al.
        Updated definitions of healthy ranges for serum alanine aminotransferase levels.
        Ann Intern Med. 2002; 137: 1-10
        • Ruhl C.E.
        • Everhart J.E.
        Upper limits of normal for alanine aminotransferase activity in the United States population.
        Hepatology. 2012; 55: 447-454
        • Arndt V.
        • Brenner H.
        • Rothenbacher D.
        • et al.
        Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality.
        Int Arch Occup Environ Health. 1998; 71: 405-412
        • Kim H.C.
        • Nam C.M.
        • Jee S.H.
        • et al.
        Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study.
        Br Med J. 2004; 328: 893
        • Lee T.H.
        • Kim W.R.
        • Benson J.T.
        • et al.
        Serum aminotransferase activity and mortality risk in a United States community.
        Hepatol. 2008; 47: 880-887
        • Ruhl C.E.
        • Everhart J.E.
        Elevated serum alanine aminotransferase and gamma-glutamyltransferase and mortality in the United States population.
        Gastroenterol. 2009; 136: e11
        • Ioannou G.N.
        • Boyko E.J.
        • Lee S.P.
        The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002.
        Am J Gastroenterol. 2006; 101: 76-82
        • Kwo P.Y.
        • Cohen S.M.
        • Lim J.K.
        ACG clinical guideline: evaluation of abnormal liver chemistries.
        Am J Gastroenterol. 2017; 112: 18-35
        • Clarke L.C.
        • Beck E.
        Plasma “alkaline phosphatase” activity. I. Normative data for growing children.
        J Pediatr. 1950; 36: 335-341
        • Birkett D.J.
        • Done J.
        • Neale F.C.
        • et al.
        Serum alkaline phosphatase in pregnancy: an immunologic study.
        Br Med J. 1966; 1: 1210-1212
        • Klaassen C.H.L.
        Age and serum alkaline phosphatase.
        Lancet. 1966; 2: 1361
        • Reichling J.J.
        • Kaplan M.M.
        Clinical use of serum enzymes in liver disease.
        Dig Dis Sci. 1988; 12: 1601-1614
        • Kao H.W.
        • Ashcavai M.
        • Redeker A.G.
        The persistence of hepatitis A IgM antibody after acute clinical hepatitis A..
        Hepatol. 1984; 4: 933-936
        • McMahon B.J.
        • Alward W.L.
        • Hall D.B.
        • et al.
        Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state.
        J Infect Dis. 1985; 151: 599-603
        • Terrault N.A.
        • Bzowej N.H.
        • Chang K.M.
        • et al.
        American Association for the Study of Liver Diseases: AASLD guidelines for treatment of chronic hepatitis B.
        Hepatology. 2016; 63: 261-283
        • Zignego A.L.
        • Deny P.
        • Feray C.
        • et al.
        Amplification of hepatitis delta virus RNA sequences by polymerase chain reaction: a tool for viral detection and cloning.
        Mol Cell Probes. 1990; 4: 43-51
        • Centers for Disease Control and Prevention
        Testing for HCV infection: an update of guidance for clinicians and laboratorians.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 362-365
        • Krawczynski K.
        • Kamili S.
        • Aggarwal R.
        Global epidemiology and medical aspects of hepatitis.
        E. Forum (Genova). 2001; 11: 166-179
        • Hewlett G.
        • Hallenberger S.
        • Rubsamen-Waigmann H.
        Antivirals against DNA viruses (hepatitis B and the herpes viruses).
        Curr Opin Pharmacol. 2004; 4: 453-464
        • Rosen H.R.
        • Chou S.
        • Corless C.L.
        • et al.
        Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C.
        Transplantation. 1997; 64: 721-726
        • Nikias G.A.
        • Batts K.P.
        • Czaja A.J.
        The nature and prognostic implications of autoimmune hepatitis with acute presentation.
        J Hepatol. 1994; 19: 225-232
        • Czaja A.J.
        • Carpenter H.A.
        Sensitivity, specificity, and predictability of biopsy interpretations in chronic hepatitis.
        Gastroenterol. 1993; 105: 1824-1832
        • Hennes E.M.
        • Zeniya M.
        • Czaja A.J.
        • et al.
        Simplified criteria for the diagnosis of autoimmune hepatitis.
        Hepatology. 2008; 48: 169-176
        • Lee W.M.
        Acute liver failure.
        Semin Respir Crit Care Med. 2012; 33: 36-45
        • Larson A.M.
        Acetaminophen hepatotoxicity.
        Clin Liver Dis. 2007; 11: 525-548
        • Smilkstein M.J.
        • Knapp G.L.
        • Kulig K.W.
        • et al.
        Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose.
        N Engl J Med. 1988; 319: 1557-1562
        • Chalasani N.
        • Fontana R.J.
        • Bonkovsky H.L.
        • et al.
        Causes, clinical features, and outcomes from a prospective study of drug induced liver injury in the United States.
        Gastroenterol. 2008; 135: 1924-1934
        • Navarro V.J.
        • Khan I.
        • Bjornsson E.
        • et al.
        Liver injury from herbal and dietary supplements.
        Hepatology. 2017; 65: 363-373
      1. LiverTox: clinical and research information on drug-induced liver injury [internet]. National Center for Biotechnology Information.
        (Available at:) (Accessed May 4, 2022)
        • Roberts E.A.
        • Schilsky M.L.
        Diagnosis and treatment of Wilson disease: an update.
        Hepatology. 2008; 47: 2089-2111
        • Budd G.
        On diseases of the liver.
        John Churchill, London1845: 146
        • Northup P.G.
        • Garcia-Pagan J.C.
        • Garcia-Tsao G.
        • et al.
        Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American association for the study of liver diseases.
        Hepatology. 2021; 73: 366-413
        • Jones R.J.
        • Lee K.S.K.
        • Beschorner W.E.
        • et al.
        Venoocclusive disease of the liver following bone marrow transplantation.
        Transplantation. 1987; 44: 778-783
        • Mellinger J.L.
        • Shedden K.
        • Winder G.S.
        • et al.
        The high burden of alcoholic cirrhosis in privately insured persons in the United States.
        Hepatology. 2018; 68: 872-882
        • Lieber C.S.
        Alcoholic liver disease: new insights in pathogenesis lead to new treatments.
        J Hepatol. 2000; 32: 113-128
        • Ellis G.
        • Goldberg D.M.
        • Spooner R.J.
        • et al.
        Serum enzyme tests in diseases of the liver and biliary tree.
        Am J Clin Pathol. 1978; 70: 248-258
        • Cohen J.A.
        • Kaplan M.M.
        The SGOT/SGPT ratio—an indicator of alcoholic liver disease.
        Dig Dis Sci. 1979; 24: 835-838
        • Nyblom H.
        • Berggren U.
        • Balldin J.
        • et al.
        High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking.
        Alcohol Alcohol. 2004; 39: 336-339
        • Stewart S.H.
        • Koch D.G.
        • Burgess D.M.
        • et al.
        Sensitivity and specificity of urinary ethyl glucuronide and ethyl sulfate in liver disease patients.
        Alcohol Clin Exp Res. 2013; 37: 150-155
        • Schröck A.
        • Wurst F.M.
        • Thon N.
        • et al.
        Assessing phosphatidylethanol (PEth) levels reflecting different drinking habits in comparison to the alcohol use disorders identification test - C (AUDIT-C).
        Drug Alcohol Depend. 2017; 178: 80-86
        • Jarvis M.
        • Williams J.
        • Hurford M.
        • et al.
        Appropriate use of drug testing in clinical addiction medicine.
        J Addict Med. 2017; 11: 163-173
        • Sayiner M.
        • Koenig A.
        • Henry L.
        • et al.
        Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United States and the rest of the world.
        Clin Liver Dis. 2016; 20: 205-214
        • GBD 2015 Mortality and Causes of Death Collaborators
        Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980- 2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1459-1544
        • Mohamad B.
        • Shah V.
        • Onyshchenko M.
        • et al.
        Characterization of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) patients without cirrhosis.
        Hepatol Int. 2016; 10: 632-639
        • Kaswala D.H.
        • Lai M.
        • Afdhal N.H.
        Fibrosis assessment in nonalcoholic fatty liver disease (NAFLD) in 2016.
        Dig Dis Sci. 2016; 61: 1356-1364
        • Zein C.O.
        • Angulo P.
        • Lindor K.D.
        When is liver biopsy needed in the diagnosis of primary biliary cirrhosis?.
        Clin Gastroenterol Hepatol. 2003; 1: 89-95
        • Maggs J.R.
        • Chapman R.W.
        An update on primary sclerosing cholangitis.
        Curr Opin Gastroenterol. 2008; 24: 377-383
        • Fausa O.
        • Schrumpf E.
        • Elgjo K.
        Relationship of inflammatory bowel disease and primary sclerosing cholangitis.
        Semin Liver Dis. 1991; 11: 31-39
        • Soto J.A.
        • Barish M.A.
        • Yucel E.K.
        • et al.
        Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography.
        Gastroenterol. 1996; 110: 589-597
        • Czaja A.J.
        The variant forms of autoimmune hepatitis.
        Ann Intern Med. 1996; 125: 588-598
        • Kornfield D.
        • Ekbom A.
        • Ihre T.
        Survival and risk of cholangiocarcinoma complicating primary sclerosing cholangitis: the Mayo Clinic experience.
        Am J Gastroenerol. 2001; 96: 1164-1169
        • Phatak P.D.
        • Bonkovsky H.L.
        • Kowdley K.V.
        Hereditary hemochromatosis: time for targeted screening.
        Ann Intern Med. 2008; 149: 270-272
        • Beutler E.
        • Gelbart T.
        • West C.
        • et al.
        Mutation analysis in hereditary hemochromatosis.
        Blood Cells Mol Dis. 1996; 22: 187-194
        • Bacon B.R.
        • Adams P.C.
        • Kowdley K.V.
        • et al.
        Diagnosis and management of hemochromatosis: 2011 practice guideline by the American association for the study of liver diseases.
        Hepatology. 2011; 54: 328-343
        • Steiner S.J.
        • Gupta S.K.
        • Croffie J.M.
        • et al.
        Serum levels of α1-antitrypsin predict phenotypic expression of the α1-antitrypsin gene.
        Dig Dis Sci. 2003; 48: 1793-1796
        • Schiff E.R.
        • Sorrell M.F.
        • Maddrey W.C.
        Schiff’s disease of the liver.
        10th edition. Lippincott Williams & Wilkins, Philadelphia, PA2007
        • Ewing J.A.
        Detecting alcoholism: the CAGE questionnaire.
        JAMA Int Med. 1984; 252: 1905-1907