Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma

Published in International Journal of the Care of the Injured on September 2009

K.K. Tan, S.L. Bang, A. Vijayan, M.T. Chiu
TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore

Abstract

Introduction

Delayed diagnosis of patients with severe liver injuries is associated with an adverse outcome. As computed tomographic (CT) scan is not always available in the management of blunt abdominal trauma worldwide, the present study was undertaken to determine the accuracy of selected haematological markers in predicting the presence of hepatic injury and its severity after blunt abdominal trauma.

Methods

A retrospective review of all patients with blunt abdominal trauma presented to our institution over a 3-year period was performed. Patients were excluded if they suffered penetrating injuries, died in the emergency department or if the required blood tests were not performed within 24 h of the accident. The grading of the hepatic injury was verified using CT scans or surgical findings.

Results

Ninety-nine patients with blunt abdominal trauma had the required blood tests performed and were included in the study. The median injury severity score was 24 (range 4–75). Fifty-five patients had hepatic injuries, of which 47.3% were minor (Grades I and II) while 52.7% had major hepatic injuries (Grades III–V). There were no patients with Grade VI injuries. 

A raised ALT was strongly associated with presence of hepatic injuries (OR, 109.8; 95% CI, 25.81–466.9). This relation was also seen in patients with raised AST > 2 times (OR, 21.33; 95% CI, 7.27–62.65). This difference was not seen in both bilirubin and ALP.

ALT > 2 times normal was associated with major hepatic injuries (OR, 7.15; 95% CI, 1.38–37.14; p = 0.012) while patients with simultaneous raised AST > 2 times and ALT > 2 times had a stronger association for major hepatic injuries (OR, 8.44; 95% CI, 1.64–43.47).

Conclusion

Abnormal transaminases levels are associated with hepatic injuries after blunt abdominal trauma. Patients with ALT and AST > 2 times normal should be assumed to possessmajor hepatic trauma and managed accordingly. Patients with normal ALT, AST and LDH are unlikely to have major liver injuries.

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