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

Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease. 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 (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of acute liver failure should be strongly suspected and hospital admission is mandatory.

Laboratory Findings

• Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease.

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 hepatic mass loss.
Total bilirubin	Elevated	Bilirubin and PT/INR will continue to rise in liver failure but if a patient 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
Toxicology screen (acetaminophen level) and blood alcohol 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
Blood lactate	Elevated	Blood lactate is elevated due to decrease hepatic clearance and ischemia to hepatic tissue
Ammonia levels	Elevated	Decrease ammonia clearance