The liver is one of the two most commonly injured solid organs after blunt trauma. There are a variety of ways to manage solid organ injury, and many trauma centers are adopting solid organ injury protocols to streamline and improve care. I am occasionally asked whether there is a place for liver function testing after hepatic injury.
In a previous post (see below), I cited some old literature refuting this idea. A more recent paper has now tried to answer this question. They retrospectively reviewed 3 years of data on patients admitted to a large hospital in Jiangsu, China. Only patients with blunt liver injury were included. They were interested to know if liver function testing helped identify the presence and severity of injury.
Here are the factoids:
- 182 patients who had blunt abdominal injury and liver function testing were identified in their registry (AST, ALT, GGT, Alk PHos, LDH, bili)
- 90 patients had liver injury and 92 did not
- Grade of liver injury was fairly evenly distributed, with a few less grade IV and V
- Elevated LFTs accurately predicted the presence of a liver injury. ALT > 57 U/L was the most accurate predictor.
- There was no correlation between LFT values and severity of liver injury
Bottom line: Basically, routine liver function testing after blunt abdominal trauma is a waste of time. And obtaining LFTs after known liver injury is an even greater waste of time. You know your patient has the injury, and you know the grade from the CT scan you obtained (hopefully). And from personal experience, there is absolutely no value in “trending” liver functions to see how the liver is healing. If the patient develops an unexpected clinical finding at some point (new pain, jaundice, fever), then you may wish to order laboratory or imaging studies to help determine if a complication is developing.
- Regions Hospital Solid Organ Injury Protocol
- Older post on LFTs in liver injury
- Bile leaks after liver injury
Reference: Role of elevated liver transaminase levels in the diagnosis of blunt liver injury after blunt abdominal trauma. Experimental and Therapeutic Medicine 4(2):255-260, 2012.