Diagnosis and Monitoring of Hepatic Injury. II. Recommendations for Use of Laboratory Tests in Screening, Diagnosis, and Monitoring

Abstract Purpose: To review information on the use of laboratory tests in screening, diagnosis, and monitoring of acute and chronic hepatic injury. Data Sources and Study Selection: A MEDLINE search was performed for key words related to hepatic diseases, including acute hepatitis, chronic hepatitis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, and etiologic causes. Abstracts were reviewed, and articles discussing use of laboratory tests selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. Recommendations: Although many specific recommendations are made in the guidelines, only some summary recommendations are listed here. In acute hepatic injury, prothrombin time and, to a lesser extent, total bilirubin are the best indicators of severity of disease. Although ALT is useful for detecting acute and chronic hepatic injury, it is not related to severity of acute hepatic injury and only weakly related to severity of chronic hepatic injury. Specific tests of viral markers should be the initial differential tests in both acute and chronic hepatic injury; when positive, they are also useful for monitoring recovery from hepatitis B and C.

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Diagnosis and Monitoring of Hepatic Injury. I. Performance Characteristics of Laboratory Tests

Clinical Chemistry ◽

10.1093/clinchem/46.12.2027 ◽

2000 ◽

Vol 46 (12) ◽

pp. 2027-2049 ◽

Cited By ~ 268

Author(s):

D Robert Dufour ◽

John A Lott ◽

Frederick S Nolte ◽

David R Gretch ◽

Raymond S Koff ◽

...

Keyword(s):

Alanine Aminotransferase ◽

Laboratory Tests ◽

Hepatic Injury ◽

Total Error ◽

Performance Characteristics ◽

Published Data ◽

Medline Search ◽

Reference Limit ◽

Reference Limits ◽

Chronic Hepatic Injury

Abstract Purpose: To review information on performance characteristics for tests that are commonly used to identify acute and chronic hepatic injury. Data Sources and Study Selection: A MEDLINE search was performed for key words related to hepatic tests, including quality specifications, aminotransferases, alkaline phosphatase, γ-glutamyltransferase, bilirubin, albumin, ammonia, and viral markers. Abstracts were reviewed, and articles discussing performance of laboratory tests were selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. The drafts were also reviewed by the Practice Guidelines Committee of the American Association for the Study of Liver Diseases and approved by the committee and the Association’s Council. Recommendations: Although many specific recommendations are made in the guidelines, some summary recommendations are discussed here. Alanine aminotransferase is the most important test for recognition of acute and chronic hepatic injury. Performance goals should aim for total error of <10% at the upper reference limit to meet clinical needs in monitoring patients with chronic hepatic injury. Laboratories should have age-adjusted reference limits for enzymes in children, and gender-adjusted reference limits for aminotransferases, γ-glutamyltransferase, and total bilirubin in adults. The international normalized ratio should not be the sole method for reporting results of prothrombin time in liver disease; additional research is needed to determine the reporting mechanism that best correlates with functional impairment. Harmonization is needed for alanine aminotransferase activity, and improved standardization for hepatitis C viral RNA measurements.

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Differential TAM receptor regulation of hepatic physiology and injury

10.1101/2020.03.13.990143 ◽

2020 ◽

Author(s):

Anna Zagórska ◽

Paqui G. Través ◽

Lidia Jiménez-García ◽

Jenna D. Strickland ◽

Francisco J. Tapia ◽

...

Keyword(s):

Liver Disease ◽

Tyrosine Kinases ◽

Hepatic Injury ◽

Cytokine Production ◽

Receptor Tyrosine Kinases ◽

Receptor Regulation ◽

Design And Implementation ◽

Acute Hepatic Injury ◽

Chronic Hepatic Injury ◽

Acetaminophen Intoxication

AbstractThe TAM receptor tyrosine kinases (RTK) Mer and Axl have been implicated in liver disease, yet our understanding of their roles in liver homeostasis and injury is limited. We therefore examined the performance of Mer and Axl mutant mice during aging, and in four models of liver injury. We find that Mer and Axl are most prominently expressed in Kupffer and hepatic endothelial cells, and that as Axl-/-Mertk-/- mice normally age, they develop profound liver disease. We further find that Mer signaling is critical to the phagocytosis of apoptotic hepatocytes that are generated during acute hepatic injury, and that Mer and Axl act in concert to inhibit injury-triggered cytokine production. TAM expression in Kupffer cells is crucial for these effects. In contrast, we show that Axl is uniquely important in mitigating liver damage during acute acetaminophen intoxication. Finally, we demonstrate that Axl exacerbates the fibrosis that develops in a model of chronic hepatic injury. These divergent effects have important implications for the design and implementation of TAM-directed therapeutics that target these RTKs in the liver.

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Up-flow roughing filtration: rehabilitation of a water treatment plant in Tarata, Bolivia

Water Science & Technology ◽

10.2166/wst.1998.0346 ◽

1998 ◽

Vol 37 (9) ◽

pp. 105-112 ◽

Cited By ~ 4

Author(s):

Ana María Ingallinella ◽

Luis María Stecca ◽

Martin Wegelin

Keyword(s):

Water Treatment ◽

Pilot Plant ◽

Laboratory Tests ◽

Treatment Plant ◽

Water Treatment Plant ◽

Horizontal Flow ◽

Design Parameters ◽

Sand Filters ◽

Chemical Products ◽

Made In

This paper presents the methodology used for the rehabilitation of the pretreatment stage in a water treatment plant for a village located in Bolivia which has 3500 inhabitants. The treatment plant was initially composed by horizontal-flow roughing filters and slow sand filters, but due to the high contents of colloidal turbidity of the providing source, it did not work properly. A plan of rehabilitation was made which comprised laboratory tests, pilot tests and proposal of modifications based on the results of previous stages. The laboratory tests were made in order to find the optimum conditions to coagulate the raw water. It was found that horizontal-flow roughing filters must be turned into up-flow roughing filters, so a pilot plant was built and was operated for three months in order to find suitable design parameters. The results obtained obtained during the operation of the pilot plant and the proposal of modifications are presented. The results of operation of the final plant, which are also reported, demonstrated the advantages of the up-flow roughing filtration as a pretreatment stage when it is necessary to add chemical products in small treatment plants.

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Arbutin attenuates ethanol‐induced acute hepatic injury by the modulation of oxidative stress and Nrf‐2/HO‐1 signaling pathway

Journal of Biochemical and Molecular Toxicology ◽

10.1002/jbt.22872 ◽

2021 ◽

Author(s):

Rongsheng Wang ◽

Jinji Mu

Keyword(s):

Oxidative Stress ◽

Signaling Pathway ◽

Hepatic Injury ◽

Acute Hepatic Injury

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Acute liver injury associated with Oxyfluorfen toxicity

SAGE Open Medical Case Reports ◽

10.1177/2050313x211000454 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110004

Author(s):

Selladurai Pirasath ◽

Ayshanie Gayanthika Samasundara Mudiyanselage ◽

Manosha Harshani Seneviratne

Keyword(s):

Sri Lanka ◽

Liver Injury ◽

Young Woman ◽

Broad Spectrum ◽

Hepatic Injury ◽

Acute Liver Injury ◽

Toxic Dose ◽

Acute Hepatic Injury ◽

Haem Biosynthesis ◽

Spectrum Control

Oxyfluorfen is a phenoxyphenyl-type herbicide which is used for broad-spectrum control of broadleaf and grassy weeds. Ingestion of toxic dose of oxyfluorfen can be fatal among animals. However, toxicity to humans are rare in literature. The alterations in haem biosynthesis (anaemia) and in liver are the primary toxic effects. There are no specific antidotes and none of the current treatments have proven efficacious till date. Therefore, prevention needs to be the utmost priority, and on exposure, aggressive decontamination should be initiated. Herein, we described an oxyfluorfen toxicity with acute hepatic injury in a young woman who presented with a deliberate self-harming with an oxyfluorfen poisoning in Sri Lanka.

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Ethnicity and Antipsychotic Response

Annals of Pharmacotherapy ◽

10.1177/106002809703101114 ◽

1997 ◽

Vol 31 (11) ◽

pp. 1360-1369 ◽

Cited By ~ 55

Author(s):

Edyta J Frackiewicz ◽

John J Sramek ◽

John M Herrera ◽

Neil M Kurtz ◽

Neal R Cutler

Keyword(s):

African Americans ◽

Environmental Factors ◽

Racial Differences ◽

Future Research ◽

Racial Groups ◽

Prescribing Practices ◽

Data Synthesis ◽

Medline Search ◽

Study Selection ◽

And Control

OBJECTIVE: To review the data generated by studies examining interethnic/racial differences in response to antipsychotics. DATA SOURCES: A MEDLINE search (1966-19%) identified all articles examining differences in antipsychotic response among Caucasians, Asians, Hispanics, and African-Americans, as well as articles evaluating postulated mechanisms for these differences. STUDY SELECTION: All abstracts, studies, and review articles were evaluated. DATA SYNTHESIS: Ethnic/racial differences in response to antipsychotic medications have been reported and may be due to genetics, kinetic variations, dietary or environmental factors, or variations in the prescribing practices of clinicians. Studies suggest that Asians may respond to lower doses of antipsychotics due to pharmacokinetic and pharmacodynamic differences. Research relevant to African-Americans is limited, but some studies suggest that differences in this group may be due to clinician biases and prescribing practices, rather than to pharmacokinetic or pharmacodynamic variability. CONCLUSIONS: Future research directed at validating the hypotheses that different ethnic/racial groups show variations in response to antipsychotics should focus on homogenous ethnic groups, use recent advances in pharmacogenetic testing, and control for such variables as observer bias, gender, disease chronicity, dietary and environmental factors, and exposure to enzyme-inducing and -inhibiting agents. Clinicians should be aware that potential interethnic/racial differences in pharmacodynamics and pharmacokinetics may exist that can alter response to antipsychotics.

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