From the Research
Management of severely elevated GGT indicating severe liver dysfunction requires a comprehensive approach, prioritizing the identification and addressing of the underlying cause, as well as supportive care and regular monitoring, as supported by the most recent study 1.
Key Considerations
- Identify and address the underlying cause, which may include alcohol cessation, medication review to discontinue hepatotoxic drugs, and treatment of viral hepatitis if present.
- Supportive care is essential, including maintaining adequate nutrition with a low-sodium diet (2000 mg/day) if ascites is present, and protein intake of 1.2-1.5 g/kg/day unless hepatic encephalopathy is present.
- Medications may include diuretics like spironolactone (starting at 100 mg daily) and furosemide (starting at 40 mg daily) for ascites management, lactulose (30-45 mL every 6-8 hours) for hepatic encephalopathy, and beta-blockers like propranolol (20-40 mg twice daily) or nadolol (20-40 mg daily) for portal hypertension.
- N-acetylcysteine (150 mg/kg IV loading dose, then 50 mg/kg every 4 hours for 17 doses) may be used in acute liver failure.
- Regular monitoring of liver function tests, coagulation parameters, and renal function is crucial, as highlighted in the study 2.
- Patients with decompensated cirrhosis should be evaluated for liver transplantation, considering the prognostic value of GGT levels, as shown in the study 1.
Underlying Causes and GGT Levels
- The study 2 found that GGT levels had different characteristics in different liver diseases, which were closely related to the pathogenesis of liver diseases.
- The study 3 suggested that increased GGT activities in alcoholic liver disease can be ascribed primarily to hepatic enzyme induction rather than to liver cell injury.
- The study 1 found that serum level of GGT can be used to identify patients with primary biliary cholangitis at risk for liver transplantation or death, and increase the prognostic value of ALP measurement.
Monitoring and Prognosis
- Regular monitoring of liver function tests, coagulation parameters, and renal function is crucial, as highlighted in the study 2.
- The study 1 found that serum level of GGT at 12 months after treatment higher than 3.2-fold the upper limit of normal (ULN) identified patients who required liver transplantation or with liver-related death at 10 years with an area under the receiver operating characteristic curve of 0.70.
- The study 4 suggested that people with high serum GGT have higher mortality, partly because of the association between GGT and other risk factors and partly because GGT is an independent predictor of risk.