Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

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Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

10.21203/rs.3.rs-40069/v3 ◽

2020 ◽

Author(s):

Anup Shrestha ◽

Harish Chandra Neupane ◽

Kishor Kumar Tamrakar ◽

Abhishek Bhattarai ◽

Gaurav Katwal

Keyword(s):

Liver Injury ◽

Confidence Interval ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Liver Enzymes ◽

Categorical Variables ◽

Tertiary Center ◽

Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on duty surgical residents in the Emergency Department. Based on the imaging and operative finding patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury). The Chi-squared test was used for categorical variables as appropriate, and Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using Kruskal-Wallis test. The Receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver to a tertiary center.

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Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

10.21203/rs.3.rs-40069/v2 ◽

2020 ◽

Author(s):

Anup Shrestha ◽

Harish Chandra Neupane ◽

Kishor Kumar Tamrakar ◽

Abhishek Bhattarai ◽

Gaurav Katwal

Keyword(s):

Liver Injury ◽

Blood Transfusion ◽

Confidence Interval ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Liver Enzymes ◽

Tertiary Center ◽

Significant Difference

Abstract Background: The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in every hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH. Results: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The median of AST and ALT of patients requiring blood transfusion was more than that of the patient not requiring blood transfusion(p<0.05). The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively. Conclusion: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.

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Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00332-1 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Anup Shrestha ◽

Harish Chandra Neupane ◽

Kishor Kumar Tamrakar ◽

Abhishek Bhattarai ◽

Gaurav Katwal

Keyword(s):

Liver Injury ◽

Confidence Interval ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Liver Enzymes ◽

Categorical Variables ◽

Tertiary Center ◽

Significant Difference

Abstract Background The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT. Results Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86–0.98) and of ALT was 0.92 (95% confidence interval 0.83–0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively. Conclusion In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.

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The predictive role of amylase and lipase levels on pancreas injury diagnosis in patients with blunt abdominal trauma

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2019-0066 ◽

2020 ◽

Vol 41 (3) ◽

Author(s):

Seyed Mohammad Hosseininejad ◽

Farzad Bozorgi ◽

Touraj Assadi ◽

Seyyed Hosein Montazar ◽

Fatemeh Jahanian ◽

...

Keyword(s):

Ct Scan ◽

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Pancreatic Injury ◽

Laboratory Findings ◽

Lipase Enzyme ◽

Significant Difference ◽

Predictive Role

AbstractObjectivesDespite the low incidence of pancreatic injury in the abdominal blunt trauma (BTA), its early diagnosis is very important; since pancreatic injury is associated with high rates of morbidity and mortality. However, due to the high association of pancreatic injury with injury of other abdominal organs, its diagnosis may be delayed and complicated. The use of imaging modalities is also subject to limitations for reasons such as cost, unavailability, and harmfulness. Consequently, the present study aimed to investigate the predictive role of amylase and lipase enzyme levels in the final diagnosis of pancreatic injury in patients with BTA.MethodsIn a prospective diagnostic study, 384 patients with BTA referring to Imam Khomeini hospital of Sari (north of Iran) were enrolled according to the inclusion and exclusion criteria. Initial patient data including age and sex were recorded. Blood samples were analyzed in the laboratory to measure complete blood count (CBC), amylase and lipase enzyme levels. Patients were followed up during hospitalization and focal ultrasound for abdominal trauma (FAST), CT-Scan and laparotomy results were recorded. Finally, the data was analyzed using SPSS version 22.ResultsThe level of amylase enzyme was significantly higher in males (p = 0.04), but the level of lipase enzyme was not significantly different between two genders (p > 0.05). The most common symptoms and signs in patients were pain, tenderness, and hematoma, respectively. The frequency of pancreatic injury in all patients with blunt abdominal trauma was 7.5% based of FAST, 7% based on CT-Scan and 12.4% based on laparotomy. Comparison of laboratory findings based on FAST, CT-Scan and laparotomy results showed that the level of amylase and lipase enzymes in patients with internal organ and pancreatic damage were higher than in patients without internal organ injury (p < 0.05). But based on FAST results; patients with pancreatic injury and injury of other organs had no significant difference (p > 0.05). However, comparison of laboratory findings based on CT-Scan and laparotomy results showed a significant increase in the level of amylase and lipase enzymes in patients with pancreatic trauma compared to patients with injury of other organs (p < 0.001).ConclusionsThe results of this study showed that pancreatic injury in blunt trauma is associated with a significant increase in levels of amylase and lipase enzymes. In addition, an increase in levels of amylase and lipase enzymes is associated with internal organ damage. Serum amylase and lipase levels can be used as useful biomarkers to decide whether to perform CT-Scan or laparotomy.

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Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries after Blunt Trauma: Correlation with Trauma Surgery Findings in 163 Patients

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.07.003 ◽

2017 ◽

Vol 68 (3) ◽

pp. 276-285 ◽

Cited By ~ 8

Author(s):

Francesco Cinquantini ◽

Gregorio Tugnoli ◽

Alice Piccinini ◽

Carlo Coniglio ◽

Sergio Mannone ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Gold Standard ◽

Clinical Management ◽

Trauma Surgery ◽

Trauma Patients ◽

Increased Risk

Background and Aims Laparotomy can detect bowel and mesenteric injuries in 1.2%–5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management. Materials and Methods Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings. Results We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed. Conclusions Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.

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Comparison of positive predictive value of computed tomography versus diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.06.3440 ◽

2019 ◽

Vol 26 (06) ◽

Author(s):

Abdul Ghaffar ◽

Saeed Mahmood ◽

Muhammad Kareemullah ◽

Saqib Uddin Khan ◽

Ambreen Akram ◽

...

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Peritoneal Lavage ◽

Organ Damage ◽

Solid Organ ◽

Diagnostic Peritoneal Lavage

Background: Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. Objectives: To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: Data Collection: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CT-scan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT.

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Combination of liver enzymes, amylase and abdominal ultrasound tests have acceptable diagnostic values as an alternative test for abdominopelvic CT scan in blunt abdominal trauma

Open Access Emergency Medicine ◽

10.2147/oaem.s207066 ◽

2019 ◽

Vol Volume 11 ◽

pp. 205-210

Author(s):

Reza Mosaddegh ◽

Samane Nabi ◽

Sogand Daei ◽

Fatemeh Mohammadi ◽

Gholamreza Masoumi ◽

...

Keyword(s):

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Liver Enzymes ◽

Abdominal Ultrasound ◽

Abdominopelvic Ct ◽

Diagnostic Values ◽

Alternative Test

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Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma

Experimental and Therapeutic Medicine ◽

10.3892/etm.2012.575 ◽

2012 ◽

Vol 4 (2) ◽

pp. 255-260 ◽

Cited By ~ 19

Author(s):

ZHIQIANG TIAN ◽

HONG LIU ◽

XIAOFANG SU ◽

ZHENG FANG ◽

ZHITAO DONG ◽

...

Keyword(s):

Liver Injury ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Liver Transaminase ◽

Elevated Liver Transaminase

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Evaluating the role of liver enzymes as predictors of severity of liver injury in patients with blunt abdominal trauma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172429 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2462

Author(s):

Preetha Prasad ◽

Abhijith Acharya ◽

Gopi Ellikunnel Vithon ◽

Girish N. M. Kumar

Keyword(s):

Liver Injury ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Liver Enzymes ◽

Liver Trauma ◽

Organ Injury ◽

Contrast Enhanced Ct ◽

Hepatic Transaminases ◽

Contrast Enhanced ◽

Enhanced Ct

Background: Liver is the 2nd most common organ affected in patients with blunt abdominal trauma (BAT). Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, a challenge exists in centers devoid of CT scan, where an elevation in hepatic transaminases may provide guidance for the emergency physician in seeking further imaging and/or surgical consultation.Methods: In patients with suspected BAT blood samples were taken for estimation of liver enzymes (AST and ALT). All patients underwent contrast enhanced CT of the abdomen. Hemodynamically unstable patients were taken up for laparotomy and the findings were recorded. Based on imaging / surgery patients were subdivided into 2 groups (with and without liver injury). Liver injuries were graded according to organ injury scale by American Association of Surgery for Trauma.Results: ALT>100 units had 100% sensitivity and specificity improved to 83.78%. The mean level of ALT in patients without liver injury was around 64. This increased to 142 in grade 1 and upto 780 units in grade 4 injury. The same rising trend was seen when AST was evaluated against grade of Liver injury. This was statistically significant (p<0.01).Conclusions: ALT is the better of the transaminases in predicting liver injury. The rise in transaminases is directly proportional to grade of liver injury.

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