Risk factors and severity of acute liver injury in non-chronic liver disease and chronic liver disease patients

Kerdsin S; Norasetkun R; Khamwang W; Phensombun A

Authors

Kerdsin S Internal Medicine Department, Somdejphrajaotaksin Maharaj Hospital, Tak
Norasetkun R Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Somdejphrajaotaksin Maharaj Hospital, Tak
Khamwang W Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Somdejphrajaotaksin Maharaj Hospital, Tak
Phensombun A Somdejphrajaotaksin Maharaj Hospital Medical Education Center, Somdejphrajaotaksin Maharaj Hospital, Tak

Keywords:

acute liver injury, chronic liver disease

Abstract

Objectives To study factors related to acute liver injury and compare the severity and risk of those factors in patients with and without chronic liver disease.

Methods This cross-sectional study of 323 patients admitted to Somdejphrajaotaksin Maharaj Hospital between 1 January and 30 September 2019, analyzing data collected on the clinical background, signs and symptoms, and laboratory results of those patients.

Results Of the 323 patients in the study, 188 did not have chronic liver disease (58.2%) and 135 had chronic liver disease (41.8%). Risk factors for acute liver injury in the chronic liver disease group included bacterial infection (33.3%) and spontaneous bacterial peritonitis (4.4%), much significantly higher than the rates in the no chronic disease group. However, the risk factors excessive consumption of alcohol (30.3%) and dengue infection (11.2%) in the no chronic liver disease group were significantly higher than in the chronic disease group. Both groups had a high incidence of disease severity as well as a high incidence of complications and mortality, although the mortality rate was higher in the chronic liver disease group (15.0% vs. 6.9%).

Conclusions The types and frequencies of risk factors for acute liver injury in patients with chronic liver disease and those with no chronic liver disease groups are different. The incidence of bacterial infection and spontaneous bacterial peritonitis is higher in patients with chronic liver disease. The incidence of excessive alcohol consumption and dengue infection is much higher in patients without chronic liver disease. Both groups have high levels of disease severity, complications and mortality. Sepsis is the major cause of mortality, especially in patients with chronic liver disease.

References

1. Thanapirom K, Treeprasertsuk S, Soonthornworasiri N, Poovorawan K, Chaiteerakij R, Komolmit P, et al. The incidence, etiologies, outcomes, and predictors of mortality of acute liver failure in Thailand: a population-base study. BMC Gastroenterology. 2019;19:18.
2. Arndt V, Brenner H, Rothenbacher D, Zschenderlein B, Fraisse E, Fliedner TM. Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality. Int Arch Occup Environ Health. 1998;71:405-12.
3. Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ. 2004;328:983.
4. Ruhl CE, Everhart JE. Elevated serum alanine aminotransferase and γ-glutamyltransferase and mortality in the United States population. Gastroenterology. 2009;136:477-85.
5. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. American Journal of Gastroenterology. 2017;112:18-35.
6. Bunchorntavakul C. Acute liver failure. Thai Journal of Hepatology. 2018;1:1-13.
7. Koch DG, Speiser JL, Durkalski V, Fontana RJ, Davern T, McGuire B, et al. The natural history of severe acute liver injury. The American journal of gastroenterology. 2017;112:1389-96.
8. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013; 144:1426-37.
9. Maipang K, Potranun P, Chainuvati S, Nimanong S, Chotiyaputta W, Tanwandee T, et al. Validation of the prognostic models in acute-on-chronic liver failure precipitated by hepatic and extrahepatic insults. PLOS ONE. 2019;14:1-16.
10. Noor MT, Manoria P. Immune Dysfunction in Cirrhosis. J Clin Transl Hepatol. 2017;5:50-8.
11. Chumpu R, Khamsemanan N, Nattee C. The association between dengue incidences and provincial-level weather variables in Thailand from 2001 to 2014. PLoS One. 2019;14:e0226945.