Near Normal Aminotransferase Levels Reported in Alcoholic Cirrhosis Patients

Alcoholic cirrhosis affects around 1 in 400 adults in the USA. It is an advanced form of liver disease, which occurs when chronic ethanol use leads to inflammation and cirrhosis or scarring of the liver. Less than 50% of people diagnosed with advanced liver disease due to cirrhosis survive for one year, and so early diagnosis is crucial.

Although cirrhosis is generally not a reversible condition, early diagnosis provides physicians with an opportunity to encourage cessation of drinking and offer treatment that can reduce symptoms and increase life expectancy. A common method to diagnose patients with alcoholic cirrhosis is to look for elevated levels of enzymes known as aminotransferases in the liver.

Specialists in Hepatology at the Medical University of South Carolina (Charleston, SC, USA) carried out a retrospective cohort analysis, and identified consecutive patients with documented alcoholic cirrhosis who were admitted between January 1 2016 and December 1 2018. They examined clinical outcomes of 78 patients as a function of whether the aspartate transaminase (AST) or alanine aminotransferase (ALT) was normal or abnormal.

In the cohort of patients with alcoholic cirrhosis (age 55, 26-75; 58% male) 70 had a normal ALT and 12 had a normal AST. The average AST for all patients was 59U/L ± 34U/L (Upper Limit of Normal [ULN] = 35U/L), and the average ALT was 27U/L ± 13U/L (ULN = 45U/L). The average INR was 1.5 ± 0.5 and total bilirubin was 3.7mg/dL ± 4.9mg/dL, and 20 patients had a normal bilirubin level, including only one with an abnormal ALT level. The average model for end-stage liver disease (MELD) score was 19 ± 8 and 32% of patients died during the follow-up time period of five months. Decompensating events were identified in 78 (100%) patients. There was no correlation between complications or death and aminotransferase levels.

Don C. Rockey, MD, a Professor of Medicine and the senior author of the study, said, “We would see these patients with advanced disease and complications, yet their liver tests seemed to be normal. So, if you just looked at their liver tests, you’d say, ‘Oh no problem,’ but in fact, that wasn’t the case.”

The authors concluded that aminotransferase levels are often unremarkable in patients with alcohol related cirrhosis and bear no relationship to clinical events or outcomes. Clinicians should be cautious when interpreting aminotransferases in patients with alcoholic cirrhosis. The study was published on October 4, 2021 in The American Journal of the Medical Sciences.

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