From the Guidelines
A hepatic panel can help identify the etiology of fever by revealing liver dysfunction or damage that may be causing or contributing to the febrile state, as indicated by elevated liver enzymes, alkaline phosphatase, and bilirubin levels, which can suggest various liver disorders, such as viral hepatitis, alcoholic hepatitis, or liver abscess, that may present with fever 1.
Key Components of a Hepatic Panel
The panel typically includes measurements of:
- Liver enzymes (ALT, AST), which when elevated indicate hepatocellular injury
- Alkaline phosphatase and gamma-glutamyl transferase (GGT), which rise in cholestatic conditions
- Bilirubin levels, which increase in various liver disorders
Interpretation of Hepatic Panel Results
Elevated liver enzymes may suggest:
- Viral hepatitis
- Alcoholic hepatitis
- Drug-induced liver injury
- Liver abscess Abnormal synthetic function tests like albumin and prothrombin time can indicate more severe liver dysfunction.
Clinical Application
The panel may also reveal patterns consistent with specific conditions, such as:
- A cholestatic pattern with elevated alkaline phosphatase, which might suggest biliary tract infection (cholangitis)
- Markedly elevated transaminases, which could point to viral hepatitis or ischemic hepatitis These findings, when interpreted alongside clinical presentation and other laboratory tests, help clinicians narrow down potential infectious, inflammatory, or malignant causes of fever that involve the hepatobiliary system, as recommended by recent guidelines 1.
From the Research
Hepatic Panel and Etiology of Fever
The hepatic panel can help show the etiology of fever by identifying liver dysfunction or disease, which can be a cause of fever.
- Liver function tests, such as those included in the hepatic panel, can detect and diagnose hepatic disease, and estimate its severity 2.
- The panel includes tests such as serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin, which can indicate hepatocellular injury or cholestatic injury 3.
- Elevated levels of these tests can guide the evaluation of the underlying cause of liver disease, such as viral hepatitis, nonalcoholic fatty liver disease, or autoimmune hepatitis 3.
- The degree of elevation of ALT and/or AST can help determine the severity of liver disease and guide further testing, such as testing for viral hepatitis or hereditary hemochromatosis 3.
- A liver biopsy may be considered if serologic testing and imaging fail to elucidate a diagnosis, to stage a condition, or when multiple diagnoses are possible 3.
Liver Function Tests
- Liver function tests can be used to detect liver disease, and the hepatic panel is a common test used to evaluate liver function 2.
- The tests included in the hepatic panel can indicate liver dysfunction or disease, which can be a cause of fever.
- Effective interpretation of the hepatic function panel requires knowledge of underlying pathophysiology and the characteristics of panel tests 2.
Evaluation of Abnormal Liver Chemistries
- Clinicians are required to assess abnormal liver chemistries on a daily basis, and the hepatic panel is a common test used to evaluate liver function 3.
- The evaluation of hepatocellular injury includes testing for viral hepatitis, assessment for nonalcoholic fatty liver disease, and screening for hereditary hemochromatosis, among other tests 3.
- The evaluation of an alkaline phosphatase elevation determined to be of hepatic origin includes testing for primary biliary cholangitis and primary sclerosing cholangitis 3.