Levels and initial course of serum alanine aminotransferase can predict outcome of patients with Budd-Chiari syndrome
| Autor: | Aurélie Plessier, Claire Francoz, Dominique Valla, Violaine Ozenne, Rami Moucari, Ludivine Douarin, Audrey Imbert, C. Denié, Richard Moreau, Sylvie Escolano, François Durand, Didier Lebrec, Dominique Cazals–Hatem, Pierre-Emmanuel Rautou |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Serum medicine.medical_specialty Necrosis Time Factors Budd-Chiari Syndrome Gastroenterology Liver disease Interquartile range Internal medicine medicine Humans Alanine aminotransferase Survival analysis Retrospective Studies Hepatology business.industry Liver cell Retrospective cohort study Alanine Transaminase Middle Aged medicine.disease Prognosis Survival Analysis digestive system diseases Surgery Budd–Chiari syndrome Female medicine.symptom business |
| Zdroj: | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 7(11) |
| ISSN: | 1542-7714 |
| Popis: | Patients with Budd-Chiari syndrome can present with acute, subacute, or chronic disease; the definitions and significance of these variants have been disputed. An increased level of serum alanine aminotransferase (ALT) is an objective marker for acute liver injury. We analyzed the significance of changes in ALT levels in Budd-Chiari syndrome patients.We performed a retrospective analysis of data from 96 consecutive Budd-Chiari syndrome patients.A threshold peak ALT level that was 5-fold the upper limit of normal distinguished 2 groups of patients: patients with high levels of ALT (40% of patients) presented with more severe liver disease, less frequent liver fibrosis, and more frequent liver cell necrosis, compared with those with ALT levels below this threshold. Patients with levels of ALT that started out high but slowly declined (50% of starting concentration within 3 days) had significantly lower odds of survival than those with a rapid decline and those with low levels of ALT (40 months transplantation-free survival, 31%, 63%, and 71%, respectively). When ALT level and the velocity of its decline are used as criterion, these data add significant prognostic information to Child-Pugh, to Clichy, and to Rotterdam Budd-Chiari syndrome scores.Determination of ALT levels at patient presentation allows 2 variants of Budd-Chiari syndrome to be distinguished. High levels of ALT reflect acute, severe, but potentially reversible, ischemic liver cell necrosis. High levels of ALT that decrease slowly predict a poor outcome for patients and might justify rapid aggressive management. |
| Databáze: | OpenAIRE |
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