From the Guidelines
Liver function tests (LFTs) can elevate into the thousands due to several serious conditions affecting the liver, with the most common causes including acute viral hepatitis, drug-induced liver injury, alcoholic hepatitis, and autoimmune hepatitis, as noted in the 2023 study by 1. The severity of LFT elevation is classified into mild, moderate, and severe, with severe elevations indicating extensive hepatocellular damage and potential acute liver failure, as discussed in the study by 1. Some of the key causes of significant LFT elevations include:
- Acute viral hepatitis (particularly hepatitis A, B, and E)
- Drug-induced liver injury from medications like acetaminophen, statins, or antibiotics
- Alcoholic hepatitis from excessive alcohol consumption
- Autoimmune hepatitis where the immune system attacks liver cells
- Ischemic hepatitis (shock liver) from reduced blood flow during circulatory failure
- Acute biliary obstruction from gallstones
- Severe cases of nonalcoholic steatohepatitis
- Certain genetic disorders like Wilson's disease or hemochromatosis As indicated in the study by 1, imaging tests are often pursued to identify the underlying etiology and guide management based on lab results. Immediate medical attention is required for LFT elevations in the thousands, as it may signal acute liver failure, which can be life-threatening, and treatment depends on identifying and addressing the underlying cause, as noted in the studies by 1. The treatment approach may involve antiviral medications, stopping hepatotoxic drugs, corticosteroids for autoimmune conditions, or surgical intervention for biliary obstruction, highlighting the importance of prompt and accurate diagnosis to guide effective management.
From the Research
Causes of Elevated Liver Function Tests (LFTs)
Elevated LFTs can be caused by various factors, including:
- Hepatocellular damage, which can be due to viral infections, drug-induced liver injury, or autoimmune hepatitis 2, 3, 4
- Cholestatic derangement, which can be caused by obstruction of the bile ducts or other liver diseases 2, 5
- Failure of synthetic function, which can be due to severe liver disease or cirrhosis 5
- Drug-induced liver injury, which can be caused by medications such as paracetamol (acetaminophen) 4, 6
- Ischemic or hypoxic hepatitis, which can be caused by conditions such as sepsis, right heart failure, or cardiogenic shock 4
- Secondary liver injury during critical diseases, such as sepsis or cardiogenic shock 4
Patterns of LFT Derangement
There are established patterns of LFT derangement, including:
- Cholestatic derangement, characterized by elevated alkaline phosphatase and gamma-glutamyl transferase 2, 5
- Hepatocellular derangement, characterized by elevated alanine transaminase and aspartate transaminase 2, 5
- Failure of synthetic function, characterized by decreased albumin and increased bilirubin 5
Clinical Significance of Elevated LFTs
Elevated LFTs can be associated with increased mortality, especially in critically ill patients 4. It is essential to identify the underlying cause of abnormal LFTs to initiate appropriate therapeutic strategies 2, 4. In some cases, elevated LFTs can be a complication of ICU treatment measures, such as drug-related hepatotoxicity or secondary sclerosing cholangitis 4.