Elevated ALT - in an Australian Hospital

StephenW

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.

StephenW

谷歌翻译是不是100％准确，仅供参考使用。
简介
整个东欧的ALT明显升高的原因
在维多利亚州的卫生检查，以确定最常见的病因
调查和完整性。
方法
所有患者ALT水平大于1000 IU /情人一个
从以医院为基础的病理报告确定了18个月期间
系统。出院摘要，紧急票据及病理报告
进行分析，以确定提出的ALT的原因，并确定
是否进行适当的筛选调查。患者
与现有的不完整的数据，从研究中排除。数据是
Bonferroni多重比较采用单因素方差分析
检验和Fisher精确检验。
结果
共有124例患者ALT> 1000 IU / L，进行了鉴定。在
其中，107例有完整的数据。整体平均年龄为
女56岁（± 2.1）和56％（N = 60）。最常见的原因
ALT升高是缺血性肝炎（N = 25，23.3％），其次是
胰原因（N = 24，22.3％），其中包括胆管炎
（10.2％），胆石症（6.5％）和胰腺炎（5.6％）。病毒性肝炎
，而6.7％的患者有19.6％的患者的基本诊断
证实对乙酰氨基酚过量。没有诊断为放电
14.9％的患者。在这些患者中，38％没有病毒执行的屏幕，
和 68％的人没有要求对乙酰氨基酚水平。对乙酰氨基酚组
异常低价竞标的比较明显高于非对乙酰氨基酚组（平均ALT
差异of 6638 IU / L，P <0.0001）。患者的平均年龄
缺血性肝炎是大于对乙酰氨基酚组和病毒性肝炎
差异45.6和28.6岁（P <0.0001）。
有没有性别差异之间的各种诊断。总体死亡率
缺血性肝炎为16.8％，是最常见的原因
（77％，N = 14）; ALT水平不高，谁死的患者。
结论胰原因和缺血性肝炎的代表
相当大的比例显ALT升高患者。这些条件
不容忽视的评估与此患者时
文稿。