Elevated liver enzymes in a German tertiary-care hospital: Distribution, diagnostic steps and diagnosis groups

Abstract

Background The determination of liver blood tests is frequently performed in hospitalized patients, and abnormal values require further diagnostics. Yet, analyses considering the management of elevated liver enzymes are missing. Therefore, this study aimed to analyze the distribution of abnormal liver function tests and the subsequent diagnostic steps across different medical specialties.

Methods From our Hannover liver-injury database, we identified 63,300 cases of patients who were hospitalized between January 2008 and July 2021 with AST or ALT > 3 ULN or AP or TBI > 2 ULN at any time point during hospitalization. Of these, 29,547 cases fulfilled the inclusion criteria and were subjected to further analysis. Cases were analyzed according to the three groups: internal medicine, surgery and others. Analyses were performed regarding baseline characteristics, liver-related diagnostics and factors influencing hospital mortality.

Results Elevated liver blood tests were mainly observed in internal medicine (n=17,762, 60.1%), followed by the surgery department 34.2% (n=10,105). Notably, 40.2% (n=11,896) developed liver enzyme elevation above the cut-offs during the hospital stay. Testing for hepatitis B and C was more often performed in the surgery department compared to in internal medicine. In total, 5.6% of the cases (n=1,640) had a liver biopsy. Hyperbilirubinemia (total bilirubine ≥ 2ULN) and AST/ALT ratios >2 were associated with in-hospital mortality.

Conclusion Clinicians are often faced with elevated liver enzymes. However, diagnostic steps differ between different specialties. Physicians should be aware of the increased in-hospital mortality in cases with hyperbilirubinemia or elevated AST/ALT ratios.

Zusammenfassung

Hintergrund Bei hospitalisierten Patienten gehört die Erhebung von Leberwerten zur Routinediagnostik, bei der im Falle einer Erhöhung eine erweiterte Diagnostik erfolgen sollte. Dennoch fehlen Studien zur Verteilung erhöhter Leberwerte in Kliniken und der durchgeführten Diagnostik, was Ziel dieser Studie ist.

Methoden Im Zeitraum von Januar 2008 und Juli 2021 wurden von der Hannoveraner Liver Injury-Datenbank 63 300 Fälle von Patienten, deren Leberwerte im Rahmen eines stationären Aufenthaltes einen der folgenden Grenzwerte überschritten haben, identifiziert: AST oder ALT > 3 ULN oder AP oder TBI > 2 ULN. 29 547 Fälle erfüllten alle Einschlusskriterien und wurden für die Analyse herangezogen. Die Fälle wurden in die Gruppen Innere Medizin, Chirurgie und Andere eingeteilt. Neben den Patientenbasisdaten wurden die diagnostischen Schritte und Faktoren mit Einfluss auf die Mortalität untersucht.

Ergebnisse Erhöhte Leberwerte finden sich hauptsächlich in der Inneren Medizin (n=17 762, 60,1%), gefolgt von der Chirurgie 34,2% (n=10 105). In 40,2% (n=11 896) entwickelten sich erhöhte Leberwerte erst im Rahmen des Aufenthaltes. Eine Testung auf das Hepatitis B- und C-Virus erfolgte häufiger in der Chirurgie als der Inneren Medizin. Eine Leberbiopsie erfolgte in 5,6% der gesamten Fälle (n=1 640). Hyperbilirubinämie (Gesamtbilirubin ≥ 2ULN) oder erhöhte AST/ALT-Quotienten > 2 waren mit einer erhöhten Mortalität assoziiert.

Schlussfolgerung Kliniker sind regelmäßig mit erhöhten Leberwerten konfrontiert. Die Diagnostik, die sie im Rahmen der Abklärung initiieren, variiert zwischen den einzelnen Fachrichtungen. Es sollte nicht außer Acht gelassen werden, dass eine Hyperbilirubinämie sowie ein erhöhter AST/ALT-Quotient in diesem Setting mit einer erhöhten Mortalität einhergeht.

Keywords

elevated liver enzymes - diagnostic approach - distribution - hepatitis

Schlüsselwörter

erhöhte Leberwerte - diagnostisches Vorgehen - Hepatitis - Diagnostik

Publication History

Received: 05 April 2023

Accepted after revision: 03 August 2023

Article published online:
10 January 2024

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