Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;12(2):326-331.
doi: 10.4103/jfmpc.jfmpc_1532_22. Epub 2023 Feb 28.

Predicting and grading liver injury in the absence of computed tomographic imaging

Mario Victor Newton  1 , S G Subramanyam  1
Affiliations

Predicting and grading liver injury in the absence of computed tomographic imaging

Mario Victor Newton et al. J Family Med Prim Care. 2023 Feb.

Abstract

Background: Even developed countries lack computed tomography (CT) scan in rural areas. Availability, affordability and accessibility of CT scan play an important role in the management of blunt hepatic trauma.

Materials and methods: A descriptive observational study among 56 hepatic blunt trauma patients as Group 1 and 56 non-hepatic blunt trauma patients as Group 2 enrolled retrospectively. Observational analysis of presence of liver trauma, grades of liver injury (I-VI) and clinical course with the liver function tests are done.

Results: Aspartate transaminase (AST) (P = 0.02) and alanine transaminase (ALT) (P = 0.003) levels were significantly elevated among Group 1. Significantly elevated levels in Group 1 than Group 2 of AST [467.5 (22-5097) vs. 95 (23-1780); P < 0.001] and of ALT [422 (28-1548) vs. 69 (20-727); P < 0.001] noted. Significant elevation of AST and ALT levels, as the AAST (American Association for the Surgery of Trauma) CT grade of liver injury increases, noted (P = 0.001). Using the ROC curve analysis, the optimal cut-off values of AST and ALT were set at ≥467.5 U/L and ≥111.5 U/L, respectively. At this cut-off, AST had sensitivity 50%, specificity 91.7%, PPV 85%, NPV 66%, ALT had sensitivity 85.3%, specificity 86.1%, PPV 85.3% and NPV 86.1% for liver injury.

Conclusion: ALT is more sensitive for liver injury. AST peak is seen in the immediate period. Combining clinical assessment, transaminase levels and Focused Assessment with Sonography in Trauma improves the sensitivity and specificity. Transaminase levels can vary with ethnicity and local epidemiological diseases; therefore, optimal cut-off levels should be established for local population. This would predict and grade the liver injury, helping in early decision-making and avoid wasting the golden hour in trauma.

Keywords: Health services research; haemorrhage; liver; tomography; transaminases; trauma; ultrasonography.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curve analysis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: Evaluation, management and outcome. Clin Pract. 2014;18(4):599. doi: 10.4081/cp.2014.599. - PMC - PubMed
    1. Höglinger M, Knöfler F, Schaumann-von Stosch R, Scholz-Odermatt SM, Eichler K. Recent trends and variations in general practitioners'involvement in accident care in Switzerland:An analysis of claims data. BMC Fam Pract. 2020;21:99. doi:10.1186/s12875-020-01170-5. - PMC - PubMed
    1. Karamercan A, Yilmaz TU, Karamercan MA, Aytaç B. Blunt abdominal trauma:Evaluation of diagnostic options and surgical outcomes. Ulus Travma Acil Cerrahi Derg. 2008;14:205–10. - PubMed
    1. Kumar MM, Venkataramanappa M, Venkataratnam I, Kumar NV, Babji K. Prospective evaluation of blunt abdominal trauma by computed tomography. Indian J Radiol Imaging. 2005;15:167–73.
    1. Kaplan U, Hatoum OA, Chulsky A, Menzal H, Kopelman D. Two weeks delayed bleeding in blunt liver injury:Case report and review of the literature. World J Emerg Surg. 2011;6:14. doi:10.1186/1749-7922-6-14. - PMC - PubMed