Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury

Patients with blunt trauma to the liver have elevated levels of liver enzymes within a short time post injury, potentially useful in screening patients for computed tomography (CT). This study was performed to define the optimal cut-off values for serum aspartate aminotransferase (AST) and alanine a...

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Bibliographic Details
Published in:BMC research notes 2016-01, Vol.9 (40), p.41, Article 41
Main Authors: Koyama, Tomohide, Hamada, Hirohisa, Nishida, Masamichi, Naess, Paal A, Gaarder, Christine, Sakamoto, Tetsuya
Format: Article
Language:English
Subjects:
Abdomen
Adult
Alanine aminotransferase
Alanine Transaminase - blood
Aspartate aminotransferase
Aspartate Aminotransferases - blood
Biomarkers - blood
Care and treatment
Diagnosis
Female
Humans
Injuries
Liver
Liver - diagnostic imaging
Liver - enzymology
Liver - injuries
Liver diseases
Male
Measurement
Medical imaging
Medical libraries
Methods
Middle Aged
Mortality
Patients
Physiological aspects
Predictive Value of Tests
Retrospective Studies
ROC Curve
Statistical analysis
Studies
Tomography, X-Ray Computed
Trauma
Trauma Severity Indices
Wounds, Nonpenetrating - blood
Wounds, Nonpenetrating - diagnosis
Wounds, Nonpenetrating - diagnostic imaging
Wounds, Nonpenetrating - pathology
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Summary:Patients with blunt trauma to the liver have elevated levels of liver enzymes within a short time post injury, potentially useful in screening patients for computed tomography (CT). This study was performed to define the optimal cut-off values for serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in patients with blunt liver injury diagnosed with contrast enhanced multi detector-row CT (CE-MDCT). All patients admitted from May 2006 to July 2013 to Teikyo University Hospital Trauma and Critical Care Center, and who underwent abdominal CE-MDCT within 3 h after blunt trauma, were retrospectively enrolled. Using receiver operating characteristic (ROC) curve analysis, the optimal cut-off values for AST and ALT were defined, and sensitivity and specificity were calculated. Of a total of 676 blunt trauma patients 64 patients were diagnosed with liver injury (Group LI+) and 612 patients without liver injury (Group LI-). Group LI+ and LI- were comparable for age, Revised Trauma Score, and Probability of survival. The groups differed in Injury Severity Score [median 21 (interquartile range 9-33) vs. 17 (9-26) (p < 0.01)]. Group LI+ had higher AST than LI- [276 (48-503) vs. 44 (16-73); p < 0.001] and higher ALT [240 (92-388) vs. 32 (16-49); p < 0.001]. Using ROC curve analysis, the optimal cut-off values for AST and ALT were set at 109 U/l and 97 U/l, respectively. Based on these values, AST ≥ 109 U/l had a sensitivity of 81%, a specificity of 82%, a positive predictive value of 32%, and a negative predictive value of 98%. The corresponding values for ALT ≥ 97 U/l were 78, 88, 41 and 98%, respectively, and for the combination of AST ≥ 109 U/l and/or ALT ≥ 97 U/l were 84, 81, 32, 98%, respectively. We have identified AST ≥ 109 U/l and ALT ≥ 97 U/l as optimal cut-off values in predicting the presence of liver injury, potentially useful as a screening tool for CT scan in patients otherwise eligible for observation only or as a transfer criterion to a facility with CT scan capability.
ISSN:1756-0500
1756-0500
DOI:10.1186/s13104-016-1863-3