Role of liver enzymes in patients with blunt trauma to liver on conservative management
DOI:
https://doi.org/10.18203/2349-2902.isj20243237Keywords:
Liver trauma, Liver enzymes, Grades of injury, Change in managementAbstract
Background: When blunt abdominal trauma occurs, the liver is the organ most often affected. The liver enzymes are often elevated in blunt trauma to the liver. However, the variation of liver enzymes among various grades of liver injury is not clear. The aim of our investigation is to determine the variation of liver enzymes across various grades of liver injury as well as whether it affects any change in management including surgical intervention.
Methods: Our research was a prospective observational study. Patients of blunt abdominal trauma having a liver damage which was detected on a contrast CT scan and managed conservatively were included. They were categorized as per the AAST (American Association for the Surgery of Trauma) system. Various biochemical markers including liver enzymes were compared between the groups. Any change in management or need for intervention was found out.
Results: A total of 35 patients has been included. Ages between 31 and 40 accounted for the majority of cases (34.3%). Our study showed male preponderance (85.7%). Most patients presented to the hospital within 24 hours of trauma (82.9%). Most of our patients had blood transfusions during their hospital stay (71.4%). AAST grade III injury was predominant (48.6%). Subgroup analysis between minor and major liver injury patients was done. No significant distinction was seen among the two groups concerning the assessed biochemical parameters. No significant variation was observed regarding the necessity for intervention.
Conclusions: Liver enzymes can not be used to differentiate among various grades of liver injury. Patients who are managed conservatively can be managed so with close monitoring and supportive treatment without the need for any intervention. However, larger and randomized studies are needed to validate the results.
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References
Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American association for the surgery of trauma organ injury scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646-55.
Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western trauma association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 2009;67(6):1144-8.
Hurtuk M, Reed RL, Esposito TJ, Davis KA, Luchette FA. Trauma surgeons practice what they preach: The NTDB story on solid organ injury management. J Trauma. 2006;61(2):243-54.
Stassen N, Bhullar I, Cheng J. Nonoperative management of blunt hepatic injury, an eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):288.
Shrestha A, Neupane HC, Tamrakar KK. Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury. Int J Emerg Med. 2021;14(7):21-32.
Tian Z, Liu H, Su X, Fang Z, Dong Z, Yu C, et al. Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma. Exp Ther Med. 2012;4(2):255-60.
Zachariah SK, Paul V, Mathews KS, Gopinath J, Celine TM, Rajeeve S. Hepatic transaminases as predictors of liver injury in abdominal trauma. Int Surg J. 2018;5:181-6.
Srivastava AR, Kumar S, Agarwal GG, Ranjan P, Blunt abdominal injury: Serum ALT. A marker of liver injury and a guide to assessment of its severity. Injury. 2007;38(9):1069-74.
Alanezi T, Altoijry A, Alanazi A, Aljofan Z, Altuwaijri T, Iqbal K, et al. Management and outcomes of traumatic liver injury: a retrospective analysis from a tertiary care centre experience. Healthcare (Basel). 2024;12(2):131.
Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. WSES expert panel. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15(1):24.
Gaillard F, Walizai T, Knipe H. AAST liver injury scale. Available at: https://doi.org/10.53347/rID-1596
Newton, Victor M, Subramanyam SG. Predicting and grading liver injury in the absence of computed tomographic imaging. J Fam Med and Prim Care. 2023;12(2):326-31.