Therapy » Clinical estimation of liver functional tests

Clinical estimation of liver functional tests

DOI: https://dx.doi.org/10.18565/therapy.2024.1.92-103

Yakovenko E.P., Strokova T.V., Yakovenko A.V., Kuvaev R.O., Ivanov A.N., Bagaeva M.E.
1) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 2) Federal Research Center for Nutrition and Biotechnology, Moscow; 3) Clinical Oncology Hospital, Yaroslavl

Abstract. To assess liver condition, a wide range of biochemical tests are used, which are referred to as “liver functional tests” (LFT). They show not only the functional condition of the liver, but also the nature of damage of its main structures. Current publication provides a detailed description of screening biochemical indexes (alanine transaminase, aspartic transaminase, alkaline phosphatase, gamma-glutamyltransferase, total, conjugated and unconjugated bilirubin, prothrombin time, prothrombin index, international normalized ratio, total protein and protein fractions), as well as the main pathogenetic liver damage syndromes (cytolytic, cholestatic, mesenchymal-inflammatory, hepatocellular failure syndrome). Correct LFT interpretation allows to determine the etiology, severity, clinical course and prognosis of the disease, as well as assess the efficacy of therapy. Current review analyzes various changes in LFT taking place in clinical practice. Lliterature search was carried out in the search engines PubMed, Google Scholar, at the portal archive.org/details/hepatology, books.google.ru.

Keywords: hepatocellular failure syndrome, mesenchymal-inflammatory syndrome, cholestasis syndrome, cytolysis syndrome, non-invasive methods for liver diseases diagnosing, liver functional tests

Read entire article

Literature

1. Cuperus F.J.C., Drenth J.P.H., Tjwa E.T. Mistakes in liver function test abnormalities and how to avoid them. United European Gastroenterology (UEG). URL: https://ueg.eu/a/174 (date of access – 10.01.2024).

2. Vagvala S.H., O’Connor S.D. Imaging of abnormal liver function tests. Clin Liver Dis (Hoboken). 2018; 11(5): 128–34. https://doi.org/10.1002/cld.704. PMID: 30992803. PMCID: PMC6385957.

3. Kwo P.Y., Cohen S.M., Lim J.K. ACG clinical guideline: Evaluation of abnormal liver chemistries. Am J Gastroenterol 2017; 112(1): 18–35. https://doi.org/10.1038/ajg.2016.517. PMID: 27995906.

4. Яковенко Э.П., Агафонова Н.А., Яковенко А.В. с соавт. Патогенетический подход к выбору гепатопротекторов в терапии лекарственно-индуцированных поражений печени. Лечебное дело. 2017; (2): 34–40. (Yakovenko E.P., Agafonova N.A., Yakovenko A.V. et al. Pathogenetic approach to hepatoprotective therapy of drug-induced liver injury. Lechebnoe delo = General Medicine. 2017; (2): 34–40 (In Russ.)). EDN: YZKMZN.

5. Хазанов А.И. Функциональная диагностика болезней печени. М. Медицина. 1988; 304 с. (Khazanov A.I. Functional diagnosis of liver diseases. Moscow: Medicine. 1988; 304 pp. (In Russ.)). ISBN: 5-225-00069-X.

6. Подымова С.Д. Болезни печени. Руководство для врачей. Изд. 5-е, перераб. и доп. М.: ООО «Медицинское информационное агентство». 2018; 984 с. (Podymova, S.D. Liver diseases. Manual. Podymova S.D. The 5th ed., revised and supplemented. Moscow: Medical Informational Agency. 2018; 984 pp. (In Russ.)). ISBN: 978-5-6040008-1-6.

7. Kuntz E., Kuntz H-D. Hepatology. Principles and practice: History, morphology, biochemistry, diagnostics, clinic, therapy. Berlin: Springer-Verlag Berlin Heidelberg. 2006; 825 pp. https://doi.org/10.1007/3-540-28977-1. ISBN: 978-3-540-28977-7.

8. Kew M.C. Serum aminotransferase concentration as evidence of hepatocellular damage. Lancet. 2000; 355(9204): 591–92. https://doi.org/10.1016/S0140-6736(99)00219-6. PMID: 10696975.

9. Friedman L.S., Martin P., Munoz S.J. Laboratory evaluation of the patient with liver disease. Hepatology. A textbook of liver disease. Ed. Zakim D., Bouer Т. 4th ed. Philadelphia: Saunders Science. 2003; pp. 659–89. https://doi.org/10.11748/bjmy.issn.1006-1703.2020.08.020.

10. Dufour D.R., Lott J.A., Nolte F.S. et al. Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests. Clin Chem. 2000; 46(12): 2027–49. PMID: 11106349.

11. Katoonizadeh A., Laleman W, Verslype C. et al. Early features of acute-on-chronic alcoholic liver failure: A prospective cohort study. Gut. 2010; 59(11): 1561–69. https://doi.org/10.1136/gut.2009.189639. PMID: 20675694.

12. Henrion J. Hypoxic hepatitis. Liver Int. 2012; 32(7): 1039–52. https://doi.org/10.1111/j.1478-3231.2011.02655.x. PMID: 22098491.

13. Goldberg D.M., Martin J.V. Role of gamma-glutamyl transpeptidase activity in the diagnosis of hepatobiliary disease. Digestion. 1975; 12(4–6): 232–46. https://doi.org/10.1159/000197682. PMID: 241676.

14. Ивашкин В.Т., Широкова Е.Н., Маевская М.В. с соавт. Клинические рекомендации Российской гастроэнтерологической ассоциации и Российского общества по изучению печени по диагностике и лечению холестаза. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015; 25(2): 41–57. (Ivashkin V.T., Shirokova Ye.N., Mayevskaya M.V. et al. Clinical guidelines of the Russian Gastroenterological Association and the Russian Society on Study of the Liver on diagnostics and treatment of cholestasis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015; 25(2): 41–57 (In Russ.)). EDN: UIOSBN.

15. Ивашкин В.Т., Широкова Е.Н. Холестаз. Руководство для врачей. М.: СИМК. 2012: 175 с. (Ivashkin V.T., Shirokova Ye.N. Cholestasis. Manual. Moscow: Special Publishing House of Medical Books. 2012: 175 pp. (In Russ.)). ISBN: 978-5-91894-019-8.

16. Иванов А.Н., Яковенко Э.П., Агафонова Н.А., Яковенко А.В. Желтуха в клинической практике. Учебно-методическое пособие для врачей. М.: Издательство ООО «Постатор». 2018. 50 с. (Ivanov A.N., Yakovenko E.P., Agafonova N.A., Iakovenko A. V. Jaundice in clinical practice. Manual. Moscow: Postator Publishing House. 2018: 50 pp. (In Russ.)). ISBN: 978-588-458410-5.

17. Назаренко Г.И., Кишкун А.А. Клиническая оценка результатов лабораторных исследований. М.: Медицина. 2006: 544 с. (Nazorenko G.I., Kishkun A.A. Clinical evaluation of laboratory results. Moscow: Medicine. 2006: 544 pp. (In Russ.)). ISBN: 5-225-04579-0.

18. Maldonado O., Demasi R., Maldonado Y. et al. Extremely high levels of alkaline phosphatase in hospitalized patients. J Clin Gastroenterol. 1998; 27(4): 342–45. https://doi.org/10.1097/00004836-199812000-00013. PMID: 9855266.

19. European Association for the Study of the Liver. EASL clinical practice guidelines: Management of cholestatic liver diseases. J Hepatol. 2009; 51(2): 237–67. https://doi.org/10.1016/j.jhep.2009.04.009. PMID: 19501929.

20. Jacquemin E. Progressive familial intrahepatic cholestasis. Clin Res Hepatol Gastroenterol. 2012; 36 (Suppl 1): S26–S35. https://doi.org/10.1016/S2210-7401(12)70018-9. PMID: 23141890.

21. Whitfield J.B., Pounder R.Е., Neale G. et al. Serum γ-glytamyl transpeptidase activity in liver disease. Gut. 1972; 13(9): 702–8. https://doi.org/10.1136/gut.13.9.702. PMID: 4404786. PMCID: PMC1412378.

22. Lee J.H., Kweon O.J., Lee M.K. et al. Clinical usefulness of international normalized ratio calibration of prothrombin time in patients with chronic liver disease. Int J Hematol. 2015; 102(2): 163–69. https://doi.org/10.1007/s12185-015-1820-2. PMID: 26068391.

23. Драпкина О.М., Шепель Р.Н., Яковенко Э.П., Зятенкова Е.В. Неинвазивные методы выявления прогрессирующего фиброза у пациентов с неалкогольной жировой болезнью печени. Профилактическая медицина. 2019; 22(2): 82–88. (Drapkina O.M., Shepel R.N., Yakovenko E.P., Zyatenkova E.V. Non-invasive methods for detection of progressive fibrosis in patients with non-alcoholic fat liver disease. Profilakticheskaya meditsina = The Russian Journal of Preventive Medicine. 2019; 22(2): 82–88 (In Russ.)). https://doi.org/10.17116/profmed20192202182. EDN: ZSZCLZ.

24. Маевская М.В., Котовская Ю.В., Ивашкин В.Т. с соавт. Консенсус для врачей по ведению взрослых пациентов с неалкогольной жировой болезнью печени и ее основными коморбидными состояниями. Терапевтический архив. 2022; 94(2): 216–253. (Maevskaya M.V., Kotovskaya Y.V., Ivashkin V.T. et al. The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities. Terapevticheskiy arkhiv = Therapeutic Archive. 2022; 94(2): 216–253 (In Russ.)). https://doi.org/10.26442/00403660.2022.02.201363. EDN: CODINB.

25. European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASL – ALEH clinical practice guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015; 63(1): 237–64. https://doi.org/10.1016/j.jhep.2015.04.006. PMID: 25911335.

26. Kamada Y., Nakamura T., Isobe S. et al. SWOT analysis of noninvasive tests for diagnosing NAFLD with severe fibrosis: An expert review by the JANIT Forum. J Gastroenterol. 2023; 58(2): 79–97. https://doi.org/10.1007/s00535-022-01932-1. PMID: 36469127. PMCID: PMC9735102.

About the Autors

Emilia P. Yakovenko, MD, Dr. Sci. (Medicine), professor of the Department of gastroenterology and dietetics of the Faculty of further professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: yaep2@mail.ru
ORCID: https://orcid.org/0000-0003-1080-0004
Tatyana V. Strokova, MD, Dr. Sci. (Medicine), professor of RAS, head of the Department of gastroenterology and dietetics of the Faculty of further professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, head of the Department of pediatric gastroenterology, hepatology and diet therapy, Federal Research Center for Nutrition and Biotechnology. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: strokova_t.v@mail.ru
ORCID: https://orcid.org/0000-0002-0762-0873
Andrey V. Yakovenko, MD, PhD (Medicine), associate professor of the Department of gastroenterology and dietetics of the Faculty of further professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: iakovenko@list.ru
ORCID: https://orcid.org/0000-0001-8120-1303
Roman O. Kuvaev, MD, PhD (Medicine), associate professor of the Department of gastroenterology of the Faculty of further professional education of the Institute of continuing education and professional development, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, gastroenterologist, endoscopist at Clinical Oncology Hospital of Yaroslavl region. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: kuvaev_roman@mail.ru
ORCID: https://orcid.org/0000-0002-0070-9066
Alexander N. Ivanov, MD, PhD (Medicine), associate professor of the Department of gastroenterology and dietetics of the Faculty of further professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: anivanov76@mail.ru
ORCID: https://orcid.org/0000-0002-3169-6595
Madlena E. Bagaeva, MD, PhD (Medicine), assistant at the Department of gastroenterology and dietetics of the Faculty of further professional education, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, senior researcher at the Department of pediatric gastroenterology, hepatology and diet therapy, Federal Research Center for Nutrition and Biotechnology. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: med3794@yandex.ru
ORCID: https://orcid.org/0000-0002-1752-6901

Back to Content