From the Guidelines
Elevated liver function tests (LFTs) are primarily caused by hepatocellular injury, which can be attributed to various factors, including viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease (NAFLD) 1.
Common Causes of Elevated LFTs
- Non-alcoholic fatty liver disease (NAFLD): a spectrum of fat deposition and hepatic inflammation followed by fibrosis due to metabolic insults, with a prevalence of 20% to 30% in the general population 1
- Alcoholic liver disease: caused by excess alcohol consumption, with an AST:ALT ratio generally >2 1
- Viral hepatitis: including acute or chronic viral hepatitis, which can cause hepatocellular injury and release of ALT and AST in serum 1
- Medications/toxins: such as certain antibiotics and herbal supplements, which can induce liver injury and elevate LFTs 1
Less Common Causes of Elevated LFTs
- Autoimmune hepatitis: a rare cause of elevated LFTs, characterized by hepatocyte injury and inflammation due to autoimmune mechanisms 1
- Hemochromatosis: a genetic disorder that can cause iron overload and liver damage, leading to elevated LFTs 1
- Alpha1-antitrypsin deficiency: a rare genetic disorder that can cause liver disease and elevated LFTs 1
- Wilson disease: a rare genetic disorder that can cause copper accumulation and liver damage, leading to elevated LFTs 1 It is essential to note that elevated LFTs can be caused by various factors, and a thorough evaluation is necessary to determine the underlying cause 1.
From the FDA Drug Label
Liver: Hepatic dysfunction, including hepatitis and cholestatic jaundice, increases in serum transaminases (AST and/or ALT), serum bilirubin, and/or alkaline phosphatase, has been reported with amoxicillin and clavulanate potassium. Hepatic Dysfunction Inform patients that atorvastatin calcium tablets may cause liver enzyme elevations and possibly liver failure.
The causes of elevated liver function tests (LFTs) include:
- Hepatic dysfunction associated with certain medications, such as amoxicillin and clavulanate potassium 2 and atorvastatin calcium tablets 3
- Hepatitis and cholestatic jaundice 2
- Increases in serum transaminases (AST and/or ALT), serum bilirubin, and/or alkaline phosphatase 2
- Liver enzyme elevations and liver failure associated with atorvastatin calcium tablets 3 and 3
From the Research
Causes of Elevated Liver Function Tests (LFTs)
Elevated liver function tests can be caused by various factors, including:
- Non-alcoholic fatty liver disease (NAFLD) 4, 5, 6
- Alcohol-related liver disease (ARLD) 4
- Viral hepatitis 4
- Statin use, which can cause dose-dependent borderline elevations of liver function tests over time 7
- Turner syndrome, which has been found to have a high prevalence of elevated LFTs, particularly gamma-glutamyltransferase (GGT) 8
- Other factors such as obesity and insulin resistance, which are risk factors for unexplained abnormal LFTs 6
Patterns of Elevated LFTs
Different patterns of elevated LFTs can be associated with various conditions, including:
- Hepatocellular pattern (H pattern), which is the most common pattern in NAFLD patients 5
- Cholestatic pattern (C pattern), which is associated with advanced fibrosis and metabolic-associated comorbidities in NAFLD patients 5
- Mixed pattern (M pattern), which is also seen in NAFLD patients 5
Prevalence of Elevated LFTs
The prevalence of elevated LFTs in the general population is estimated to be around 10-20% 6, with a higher prevalence in certain populations such as those with Turner syndrome 8. Approximately 2.5% of the general population are expected to show elevated values 4.