标题: Elevated ALT - in an Australian Hospital [打印本页] 作者: StephenW 时间: 2011-8-4 09:01 标题: Elevated ALT - in an Australian Hospital
Markedly elevated serum transaminases in the hospital setting: pancreatobiliary and ischaemic causes are the most common
P MAHINDRA, DJ LEWIS, JS LUBEL
Department of Gastroenterology and Hepatology,
Eastern Health, Victoria
Introduction
The causes of markedly elevated ALT across Eastern
Health in Victoria were examined to ascertain the most common aetiologies
and completeness of investigation.
Methods
All patients with ALT levels greater than 1000 IU/Lover an
18-month period were identified from a hospital-based pathology reporting
system. Discharge summaries, Emergency notes and pathology reports
were analysed to determine the cause of raised ALT and to ascertain
whether appropriate screening investigations were performed. Patients
with incomplete data available were excluded from the study. Data were
analysed using one-way ANOVA with Bonferroni’s multiple comparison
test and Fisher’s exact test.
Results
A total of 124 patients with ALT >1000 IU/L were identified. Of
these, 107 patients had complete data. The overall average age was
56 years (± 2.1) and 56% (n = 60) were female. The most common cause
for elevated ALT was ischemic hepatitis (n = 25, 23.3%), followed by
pancreatobiliary causes (n = 24, 22.3%), which included cholangitis
(10.2%), cholelithiasis (6.5%) and pancreatitis (5.6%). Viral hepatitis was
the underlying diagnosis in 19.6%of patients, while 6.7%of patients had
confirmed paracetamol overdose. No diagnosis was made on discharge in
14.9%of patients. Of these patients, 38% had no viral screen performed,
and 68% had no paracetamol levels requested. The paracetamol group had
significantly higher ALTs compared to non-paracetamol group (mean ALT
difference of6638 IU/L, p < 0.0001). The mean age of patients with
ischemic hepatitis was greater than the paracetamol group and viral hepatitis
with differences of 45.6 and 28.6 years respectively (p < 0.0001).
There was no gender difference amongst various diagnoses. Overall mortality
was 16.8% with ischemic hepatitis being the most common cause
(77%, n = 14); ALT levels were not higher in patients who died.
Conclusion Pancreatobiliary causes and ischaemic hepatitis represent a
significant proportion of patients with markedly elevated ALT. These conditions
should not be overlooked when assessing patients with this
presentation.