interpreting your liver test results sumeet asrani md msc hepatologist baylor university medical...

Interpreting Your Liver Test Results

Sumeet Asrani MD MSc

Hepatologist

Baylor University Medical Center, Dallas

April 2015

Elevated liver tests

• Most patients with PSC have elevated liver tests

• Liver test elevation does NOT always imply that things are getting worse

• The context of elevation is very important

Liver function tests

• not specific • other disease, drugs may causes

elevations• hemolysis, muscle breakdown(AST)• hemolytic anemia or blood problems

(bilirubin)

• not sensitive• serious liver disease without

elevation in LFT’s

Bilirubin

Bilirubin

HIGH BILIRUBIN occurs due to one or more of the following

•overproduction (hemolysis)

•impaired metabolism (chronic liver disease, rare metabolic defects)

•impaired excretion (biliary obstruction)

Bilirubin

• Normal bilirubin 1 mg/dL. Usually there is some elevation 1-2 mg/dL.

• HIGH BILIRUBIN causes• Jaundice• Scleral Icterus

Alkaline phosphatase

• mechanism of increase in serum alkaline phosphatase is

• increased enzyme production by hepatocytes

• induced by bile acids which may cause leakage into blood

• normal is around 150

Aminotransferases (AST/ALT)

• Also called SGOT/SGPT

• increased serum aminotransferase levels caused by injury to enzyme-rich tissue

• enzyme-rich tissue • liver• heart• Muscle

• Normal is around 40

Aminotransferases

AST ALT

AST

ALT

Hepatocyte (Liver cell)

AST and ALT leak into bloodfrom damaged cells

hepatocyte

Elevated Liver tests• Is it real?

• Recheck

• Is the patient symptomatic?• Did we just happen to check it

• Stage of liver disease?• No scarring or some scarring• Cirrhosis• Post transplant

• Related to PSC or not related?

Location

Non liver related

Pattern

• Increased AST/ALT• Liver injury

• Increased Bilirubin/Alkaline phosphatase

• Bile duct injury

Context: Advanced Disease

• HIGH Bilirubin

• HIGH Creatinine

• HIGH INR

• LOW Platelets

• LOW Albumin

Bilirubin going up: PSC related causes

• Medication?

• Infection?

• Blockage?• Stone• Stricture

Explaining elevated liver tests

MELD score

• Mathematical model• Bilirubin• Creatinine• INR

http://reference.medscape.com/calculator/meld-score-end-stage-liver-disease

MELD score

MELD 28MELD 16

Joe and Mike: compensated cirrhotics in the community

MELD 28MELD 16

Current system: Why does Mike get the liver?

MELD c statistic: 0.87

MELD 28MELD 16

Other tests: CA 19-9

• CA 19-9• Tumor marker• Can be elevated without other

reasons• Sometimes even a blockage can

cause this number to go high

Other tests: PSC after LT

• Multiple reasons for elevation

• Weight gain: fatty liver

• Medication side effects

• NOT always imply recurrence

• Transplant center intimately involved in interpretation

Elevated liver tests

• Some elevation in liver tests is common

• Elevation is not simply an on/off position

• Context, pattern and trend is very important

Interpreting Your Liver Test Results

Sumeet Asrani MD MSc

Hepatologist

Baylor University Medical Center, Dallas

April 2015