How to Interpret Liver Function Test in Daily Practice

Authors

  • Yudith Setiati Ermaya Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
  • Dwi Prasetyo Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, Indonesia

DOI:

https://doi.org/10.58427/apghn.2.1.2023.40-52

Keywords:

interpretation, liver enzyme, liver function test, pediatric

Abstract

Background: The liver is a multi-function organ that plays a role in producing various important secrete, synthesis and metabolic functions. The term liver function test is also used to refer to the hepatocyte synthesis function, such as serum albumin and prothrombin time. In this paper, we will discuss how to interpret various liver function test results in daily practice as well as approach to abnormal liver function tests.

Discussion: Abnormal result of liver function test is frequently found in asymptomatic healthy patients who are undergoing routine screening. On the contrary, some patients with liver disease may appear with normal liver function test.  As such, there are some limitations regarding this particular test. ALT (SGPT) is the primary marker of hepatocellular injury due to it being more sensitive and specific than AST (SGOT). Conjugated bilirubin level of more than 20% of total bilirubin level is a strong indication of hepato-biliary disease and is always pathogenic. GGT is only increased in cholestatic conditions and not in bone disease. As such, GGT levels can help to distinguish abnormalities in the liver or bones in conditions of increased ALP levels in the blood.

Conclusion: Serum liver biochemistry examination is very useful and effective in assessing liver function. Understanding the proper interpretation of liver enzymes will help clinicians easier to diagnose or predict a disease as well as condition related to the liver in daily practice.

References

Haghighat M. Approach to Liver Function Tests in Children. J Compr Ped. 2014;5(2):e17526:1-4. https://doi.org/10.17795/compreped-17526

Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000;342(17):1266– 71. https://doi.org/10.1056/NEJM200004273421707

Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology. 2002 Oct; 123(4):1367-84. https://doi.org/10.1053/gast.2002.36061

Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ. 2004;328(7446):983. https://doi.org/10.1136/bmj.38050.593634.63

Berman DH, Leventhal RI, Gavaler JS, Cadoff EM, Van Thiel DH. Clinical differentiation of fulminant Wilsonian hepatitis from other causes of hepatic failure. Gastroenterology. 1991;100(4):1129–34. https://doi.org/10.1016/0016-5085(91)90294-u

Giannini E, Risso D, Botta F, Chiarbonello B, Fasoli A, Malfatti F, et al. Validity and clinical utility of the aspartate aminotransferase- alanine aminotransferase ratio in assessing disease severity and prognosis in patients with hepatitis C virus-related chronic liver disease. Arch Intern Med. 2003;163(2):218–24. https://doi.org/10.1001/archinte.163.2.218

Young S, Azzam RK. Infantile cholestasis approach and diagnostic algorithm. In: S. Guandalini, Dhawan A, Branski D, editors. Textbook of pediatric gastroenterology, hepatology and nutrition. Switzerland: Springer Inc; 2016:625­31. https://doi.org/10.1007/978-3-319-17169-2

Fallatah HI. Noninvasive biomarkers of liver fibrosis: an overview. Advances in hepatology. [Online Journal] 2014 [downloaded 5 Februari 2022]. https://doi.org/10.1155/2014/357287

Pradat P, Alberti A, Poynard T, dkk. Predictive value of ALT levels for histologic findings in chronic hepatitis C: a European collaborative study. Hepatology. 2002;36(4):973­7. https://doi.org/10.1053/jhep.2002.35530

New ALT Reference Intervals for Children and Adults. LabCorp. Directory of Services and Interpretive Guide. 2012. [downloaded 22 Januari 2022]. Available at: https://www.labcorp.com /wps/portal/ provider/ testmenu.

Pediatric Liver function test: smarter way. [downloaded 5 September 2022]. Available at http://www.criticalpediatrics.org/2015/05/pediatric-liver-function-test-smarter.html

Poynard T, Imbert-Bismut F. Laboratory Testing for Liver Disease. In Boye T, Manns M, Sanyal A, editors. Zakim and Boyer’s Hepatology : A Textbook of Liver Disease 6th Ed. Philadephia: Saunders Elsevier; 2012;201-15.

Andropoulos DB. Pediatric Normal Laboratory Values. Gregory”s Pediatric Anesthesia. Fifth Edition. Blackwell Publishing Ltd. 2012. P: 1300-14

American Gastroenterological Association medical position statement: Evaluation of liver chemistry tests. Gastroenterology. 2002; 123:1364-6. https://doi.org/10.1053/gast.2002.36060

Karpen SJ. Update on the etiologies and management of neonatal cholestasis. Clin Perinatol. 2002;29:159-80. https://doi.org/10.1016/s0095-5108(03)00069-1

Suchy FJ. Approach to the infant with cholestasis.Liver disease in children. Second edition. Philadelphia: Lippincott Williams & Wilkins; 2001:187­94.

Moyer V, Freese DK, Whintington PF, Olson AD, Brewer F, Colleti RB, dkk. Guidelines for the evaluation of cholestatic jaundice in infants: recommendation of the north american society for pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr. 2004;39:115-28. https://doi.org/10.1097/MPG.0000000000001334

Gamma Glutamyl transpeptidase [downloaded 7 February 2021]. Available at: http://previews.123rf.com/images/molekuul/molekuul1502/molekuul150200063/36765903-Gamma-glutamyltranspeptidase-1-GGT-1-gamma-GT-gamma-glutamyl-transferase-enzyme-Used-as-diagnostic-m-Stock-Photo.jpg

Whitfield J.B. Gamma Glutamyl Trasferase. Critical Reviews in Clinical Laboratory Sciences. 2001;38(4):263-355. https://doi.org/10.1080/20014091084227

Hanigan MH, Frierson HF. Immunohistochemical detection of Gama-glutamyl transpeptidase in normal human tissue. J Histochem Cytochem.1996;44:1101–8. https://doi.org/10.1177/44.10.8813074

Thapa B.R., Walia A. Liver function tests and their interpretation. Indian J Pediatr. 2007;74(7):663–71. https://doi.org/10.1007/s12098-007-0118-7

Shipman K.E, Holt A.D, Gama R. Interpretating an isolated raised serum alkaline phosphatase level in an asymptomatic patient. BMJ.2013;346:1-6. https://doi.org/10.1136/bmj.f976

Published

2023-02-28

How to Cite

1.
How to Interpret Liver Function Test in Daily Practice. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2023 Feb. 28 [cited 2024 Dec. 3];2(1):40-52. Available from: https://apghn.com/index.php/journal/article/view/35