From the Guidelines
Elevated bilirubin and ALT levels require immediate medical attention to rule out potential liver dysfunction, and patients should schedule an appointment with their healthcare provider promptly for proper assessment and diagnosis. These abnormal liver function tests can result from various conditions, including viral hepatitis, medication side effects, alcohol consumption, fatty liver disease, or autoimmune disorders, as noted in the guidelines on the management of abnormal liver blood tests 1. The severity of elevation matters, with mild increases potentially indicating minor inflammation and significant elevations signaling more serious liver damage.
According to the management of patients with liver derangement during the COVID-19 pandemic, an Asia-Pacific position statement 1, liver dysfunction in COVID-19 patients can be caused by the direct cytopathic effect of SARS-CoV-2 on hepatocytes, as well as other factors such as sepsis-associated cholestasis, ischemic hepatitis, and drug-induced liver injury. While waiting for their appointment, patients should avoid alcohol completely, discontinue any non-essential medications or supplements (after consulting their doctor), maintain hydration, and eat a healthy diet low in processed foods and saturated fats.
The doctor will likely order additional tests, such as a complete liver panel, hepatitis screening, and possibly imaging studies like an ultrasound or CT scan, to determine the underlying cause of the elevated bilirubin and ALT levels, as recommended in the guidelines on the management of abnormal liver blood tests 1. Treatment will depend entirely on the specific diagnosis, ranging from lifestyle modifications to medication adjustments or specific therapies for the underlying condition. It is essential to consider the potential impact of COVID-19 on patients with underlying liver disease, as noted in the Asia-Pacific position statement 1.
Key considerations in the management of elevated bilirubin and ALT levels include:
- Avoiding alcohol and non-essential medications
- Maintaining hydration and a healthy diet
- Undergoing additional tests, such as a complete liver panel and imaging studies
- Considering the potential impact of COVID-19 on underlying liver disease
- Seeking prompt medical attention for proper assessment and diagnosis.
From the Research
Raised Bilirubin and ALT
- Elevated levels of bilirubin and alanine aminotransferase (ALT) can indicate liver damage or disease 2, 3.
- Bilirubin is a pigment produced during the breakdown of hemoglobin, and elevated levels can cause jaundice 2, 4.
- ALT is an enzyme found primarily in the liver, and elevated levels can indicate hepatocellular damage 3.
- The ratio of AST to ALT can help differentiate between alcoholic and non-alcoholic liver disease 3.
Causes of Elevated Bilirubin and ALT
- Elevated bilirubin levels can be caused by excess bilirubin production, impaired liver uptake, impaired conjugation, or bile clearance defects 4.
- Elevated ALT levels can be caused by hepatocellular damage, which can be due to various factors such as viral hepatitis, alcoholic liver disease, or drug-induced liver injury 3.
- Other causes of elevated bilirubin and ALT include primary biliary cholangitis, non-alcoholic steatosis, and drug-induced liver disease 5, 6.
Treatment and Management
- Treatment of elevated bilirubin and ALT depends on the underlying cause of the elevation 2, 6.
- Obeticholic acid has been shown to reduce bilirubin levels in patients with primary biliary cholangitis 5.
- Ursodeoxycholic acid has been shown to reduce liver markers, including ALT and bilirubin, in patients with liver disease 6.
- Lifestyle modifications, such as abstaining from alcohol and losing weight, may also help reduce liver markers 3.