From the Guidelines
Hospitalized patients with abnormal liver function tests (LFTs) should be monitored at least twice weekly, with more frequent testing in patients on potentially hepatotoxic medication, those with pre-existing liver disease, or those with abnormal liver function. The frequency of monitoring deranged LFTs in hospitalized patients depends on the severity of abnormalities and the underlying cause. According to the most recent and highest quality study 1, it would be reasonable to monitor liver tests twice weekly in patients on potentially hepatotoxic medication, patients with pre-existing liver disease, and more frequently in any patients with abnormal liver function.
Key Considerations
- The optimal interval for liver tests is uncertain, but twice weekly monitoring is a reasonable approach for patients on potentially hepatotoxic medication or with pre-existing liver disease 1.
- More frequent testing may be necessary in patients with abnormal liver function, particularly if there is clinical deterioration or if hepatotoxic medications are being administered.
- The specific panel should include ALT, AST, alkaline phosphatase, GGT, total and direct bilirubin, and albumin to comprehensively assess liver function.
- Close monitoring is essential because rapid changes in LFTs can indicate worsening liver injury, medication toxicity, or progression of the underlying disease, allowing for timely intervention to prevent further liver damage.
Additional Recommendations
- Patients with COVID-19 and persistent liver derangement should have standard investigations for liver diseases, including serological tests for viral hepatitis 1.
- Patients with abnormal liver function should be closely monitored when using off-label medications, such as lopinavir–ritonavir, chloroquine, hydroxychloroquine, and tocilizumab 1.
- Off-label treatment for COVID-19 should be withheld in the case of moderate-to-severe liver injury 1.
From the Research
Monitoring Frequency of Liver Function Tests (LFTs)
The frequency at which LFTs should be monitored in hospitalized patients with abnormal results is not explicitly stated in the provided studies. However, the studies suggest that LFTs should be monitored regularly in certain situations:
- In patients with abnormal LFTs, the cause of the abnormality should be established, and the presence of cirrhosis should be determined 2.
- In patients taking statins, LFTs should be monitored over time to evaluate derangement in LFTs, although the elevations are often clinically and statistically insignificant 3.
- In critically ill patients, LFTs should be monitored to evaluate the prevalence, patterns, and significance of deranged LFTs, as low-grade abnormalities of LFTs are associated with mortality outcomes and clinical events on ICU 4.
- In hospitalized patients with abnormal LFTs, the evaluation process should include determining the etiology of the underlying liver disease, evaluating the severity of the liver dysfunction, and looking for the presence of associated complications 5.
- In patients with acute heart failure, LFTs should be monitored to evaluate the prevalence, clinical determinants, and prognostic consequences of abnormal LFTs, as abnormal LFTs are common in these patients and may have prognostic relevance 6.
Key Considerations
Some key considerations for monitoring LFTs in hospitalized patients with abnormal results include:
- The pattern of liver injury with statin use is not specific, and a correlation over time may not be apparent 3.
- Episodes of ventilation, haemofiltration, and hypotension during the first 48 hours are associated with an abnormal ALT on day 3 in critically ill patients 4.
- The presence of an abnormal ALT, AKP, or gammaGT is associated with an increased risk of death within 30 days of admission in critically ill patients 4.
- Abnormal LFTs are common in patients with acute heart failure and may have prognostic relevance, with elevated bilirubin being correlated with impaired hemodynamic parameters 6.