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Serial alanine aminotransferase (ALT) measurements are increasingly requested in all settings of patient care, but their interpretation has been ambiguous. There are currently no guidelines for interpreting serial ALT values. The purpose of this study was to examine the association between early ALT changes and clinical deterioration in patients with a severe acute liver injury. This was a prospective observational study of patients admitted to the hepatology and intensive care units at an urban academic medical center. All patients with ALT levels at or above 100 U/L and an ALT increase of more than 50 U/L were enrolled. All ALT levels were recorded within the first 72 hours of admission. If an ALT level was below the lower limit of normal and then rose above 100 U/L in the subsequent 7 days, a single value was recorded. We used chi-square tests to examine the association of single ALT values with clinical deterioration. Additionally, multiple logistic regression was used to examine the independent association between different ALT values with clinical deterioration. Of the 58 patients enrolled, 59.6% progressed to clinical deterioration. Early ALT levels were associated with the subsequent development of clinical deterioration. If the first ALT value was elevated, the odds ratio of clinical deterioration was 5.57 (95% CI: 2.39-12.91). In an analysis restricted to patients with a single ALT value, only those with two ALT values above the upper limit of normal had an odds ratio of 4.76 (95% CI: 1.38-16.36). Serial ALT measurements can identify patients with a severe acute liver injury who will require close follow-up and aggressive treatment.Q:
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