Acute liver failure laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged by ≈ 4-6 seconds or more (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of ALF should be strongly suspected and hospital admission is mandatory.

Laboratory Findings

LAB	values in Acute liver failure	Comments
Prothrombin time/INR	Increased	Prolonged prothrombin time, resulting in an INR ≥1.5; it shows coagulopathy which is a part of acute liver failure criteria.
Hemoglobin	Low	Anemia may be present
Liver function tests AST, ALT, alkaline phosphatase, GGT,	Elevated	Liver enzymes are elevated in acute liver failure. The decrease in liver enzymes may indicate recovery or worsening of liver failure and an indication of loss of hepatic mass.
Total bilirubin,	Elevated	Bilirubin and PT/INR will will continue to rise in liver failure bua patienttient is improving, bilirubin and PT/INT will also improve.
Albumin	Low	Albumin indicates the synthetic function of the liver.
Blood glucose	Low	Decrease hepatic glycogenolysis and gluconeogenesis
BUN and CR	Elevated	Decrease clearance in hepatorenal syndrome
Arterial blood gas
Toxicology screen (acetaminophen level)		Detectable in acetaminophen poisioning
Viral hepatitis markers: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV	Dectectable in viral hepatitis	Viral serology and PCR can detect the viral agent
Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels	Detectable in auto immune hepatitis.	Antibody screen can detect antibodies associated with autoimmune hepatitis such as anti-smooth muscle antibody or ANA.
Ceruloplasmin Level		Elevated in wilson's disease
Other metabolites (Potassium, phosphate )
Ammonia levels	Elevated	Decrease ammonia clearance

Initial laboratory examination must be extensive in order to evaluate both the etiology and severity..

Initial laboratory analysis

• Prothrombin time/INR
• Complete blood count
• Chemistries
  • Liver function test: AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin
  • Creatinine, urea/blood urea nitrogen, sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate
  • glucose
  • Amylase and lipase
• Arterial blood gas, lactate
• Blood type and screen
• Paracetamol (Acetaminophen) level, Toxicology screen
• Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
• Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels
• Ceruloplasmin Level ( when Wilson's disease suspected)
• Pregnancy test (females)
• Ammonia (arterial if possible)
• HIV status (has implication for transplantation)