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Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Washington, DC 20422, and Department of Pathology, George Washington University School of Medicine, Washington, DC 20037.
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Department of Pathology, The Ohio State University
College of Medicine, Columbus, OH 43210.
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Departments of Pathology and Laboratory Medicine, Emory
University School of Medicine, Atlanta, GA 30322.
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Department of Laboratory Medicine, University of
Washington School of Medicine, Seattle, WA 98104-2499.
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Department of Medicine, University of Massachusetts
Medical Center, Worchester, MA 06155.
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Hepatitis C Programs, National Institute of Diabetes,
Digestive, and Kidney Diseases, National Institutes of Health,
Bethesda, MD 20892, and Georgetown University School of Medicine,
Washington, DC 20037.
a Address correspondence to this author at: Pathology and Laboratory Medicine Service, 113, VA Medical Center, 50 Irving Street NW, Washington, DC 20422. Fax 202-745-8284; e-mail
d.robert.dufour{at}med.va.gov
Purpose: To review information on the use of laboratory tests in screening, diagnosis, and monitoring of acute and chronic hepatic injury.
Data Sources and Study Selection: A MEDLINE search was performed for key words related to hepatic diseases, including acute hepatitis, chronic hepatitis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, and etiologic causes. Abstracts were reviewed, and articles discussing use of laboratory tests selected for review. Additional articles were selected from the references.
Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact.
Recommendations: Although many specific recommendations are made in the guidelines, only some summary recommendations are listed here. In acute hepatic injury, prothrombin time and, to a lesser extent, total bilirubin are the best indicators of severity of disease. Although ALT is useful for detecting acute and chronic hepatic injury, it is not related to severity of acute hepatic injury and only weakly related to severity of chronic hepatic injury. Specific tests of viral markers should be the initial differential tests in both acute and chronic hepatic injury; when positive, they are also useful for monitoring recovery from hepatitis B and C.
The following articles in journals at HighWire Press have cited this article:
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  M. Lazo, E. Selvin, and J. M. Clark Brief Communication: Clinical Implications of Short-Term Variability in Liver Function Test Results Ann Intern Med, March 4, 2008; 148(5): 348 - 352. [Abstract] [Full Text] [PDF]
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 R. Goel, B. Boylan, L. Gruman, P. J. Newman, P. E. North, and D. K. Newman The proinflammatory phenotype of PECAM-1-deficient mice results in atherogenic diet-induced steatohepatitis Am J Physiol Gastrointest Liver Physiol, December 1, 2007; 293(6): G1205 - G1214. [Abstract] [Full Text] [PDF]
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 J. R. Ticehurst, F. M. Hamzeh, and D. L. Thomas Factors Affecting Serum Concentrations of Hepatitis C Virus (HCV) RNA in HCV Genotype 1-Infected Patients with Chronic Hepatitis J. Clin. Microbiol., August 1, 2007; 45(8): 2426 - 2433. [Abstract] [Full Text] [PDF]
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 A. Mukherjee, Y. Sidis, A. Mahan, M. J. Raher, Y. Xia, E. D. Rosen, K. D. Bloch, M. K. Thomas, and A. L. Schneyer FSTL3 deletion reveals roles for TGF-beta family ligands in glucose and fat homeostasis in adults PNAS, January 23, 2007; 104(4): 1348 - 1353. [Abstract] [Full Text] [PDF]
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 J. J. Saukkonen, D. L. Cohn, R. M. Jasmer, S. Schenker, J. A. Jereb, C. M. Nolan, C. A. Peloquin, F. M. Gordin, D. Nunes, D. B. Strader, et al. An Official ATS Statement: Hepatotoxicity of Antituberculosis Therapy. Am. J. Respir. Crit. Care Med., October 15, 2006; 174(8): 935 - 952. [Abstract] [Full Text] [PDF]
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 H Tilg and A Kaser Predicting mortality by the Glasgow alcoholic hepatitis score: the long awaited progress? Gut, August 1, 2005; 54(8): 1057 - 1059. [Full Text] [PDF]
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 E. G. Giannini, R. Testa, and V. Savarino Liver enzyme alteration: a guide for clinicians Can. Med. Assoc. J., February 1, 2005; 172(3): 367 - 379. [Abstract] [Full Text] [PDF]
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 R. Rej Clinical Chemistry through Clinical Chemistry: A Journal Timeline Clin. Chem., December 1, 2004; 50(12): 2415 - 2458. [Abstract] [Full Text] [PDF]
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 K. A. Musana, S. H. Yale, and A. S. Abdulkarim Tests of Liver Injury Clin. Med. Res., May 1, 2004; 2(2): 129 - 131. [Full Text] [PDF]
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 M. J. J. Ronis, R. Hakkak, S. Korourian, E. Albano, S. Yoon, M. Ingelman-Sundberg, K. O. Lindros, and T. M. Badger Alcoholic Liver Disease in Rats Fed Ethanol as Part of Oral or Intragastric Low-Carbohydrate Liquid Diets Experimental Biology and Medicine, April 1, 2004; 229(4): 351 - 360. [Abstract] [Full Text] [PDF]
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 E. Giannini, D. Risso, F. Botta, B. Chiarbonello, A. Fasoli, F. Malfatti, P. Romagnoli, E. Testa, P. Ceppa, and R. Testa Validity and Clinical Utility of the Aspartate Aminotransferase-Alanine Aminotransferase Ratio in Assessing Disease Severity and Prognosis in Patients With Hepatitis C Virus-Related Chronic Liver Disease Arch Intern Med, January 27, 2003; 163(2): 218 - 224. [Abstract] [Full Text] [PDF]
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I. Ryden, P. Pahlsson, and S. Lindgren Diagnostic Accuracy of {alpha}1-Acid Glycoprotein Fucosylation for Liver Cirrhosis in Patients Undergoing Hepatic Biopsy Clin. Chem., December 1, 2002; 48(12): 2195 - 2201. [Abstract] [Full Text] [PDF]
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A. H.B. Wu, R. Valdes Jr, and C. D. Hawker Guidelines and Recommendations in Laboratory Medicine Clin. Chem., July 1, 2002; 48(7): 1135 - 1136. [Full Text] [PDF]
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F. S. Nolte, M. W. Fried, M. L. Shiffman, A. Ferreira-Gonzalez, C. T. Garrett, E. R. Schiff, S. J. Polyak, and D. R. Gretch Prospective Multicenter Clinical Evaluation of AMPLICOR and COBAS AMPLICOR Hepatitis C Virus Tests J. Clin. Microbiol., November 1, 2001; 39(11): 4005 - 4012. [Abstract] [Full Text] [PDF]
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M. J. McQueen Overview of Evidence-based Medicine: Challenges for Evidence-based Laboratory Medicine Clin. Chem., August 1, 2001; 47(8): 1536 - 1546. [Abstract] [Full Text] [PDF]
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A. Larsson, N. Tryding, and D. R. Dufour Is It Necessary to Order Aspartate Aminotransferase with Alanine Aminotransferase in Clinical Practice? Dr. Dufour responds: Clin. Chem., June 1, 2001; 47(6): 1133 - 1135. [Full Text] [PDF]
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D. R. Dufour, J. A. Lott, F. S. Nolte, D. R. Gretch, R. S. Koff, and L. B. Seeff Diagnosis and Monitoring of Hepatic Injury. I. Performance Characteristics of Laboratory Tests Clin. Chem., December 1, 2000; 46(12): 2027 - 2049. [Abstract] [Full Text] [PDF]
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