Liver biochemical tests that detect injury to hepatocytes
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
A number of blood tests are available that reflect the condition of the liver. The most common tests used in clinical practice include the serum aminotransferases, bilirubin, alkaline phosphatase, albumin, and prothrombin time. These tests are often referred to as "liver function tests", although this term is somewhat misleading since most do not accurately reflect how well the liver is functioning, and abnormal values can be caused by diseases unrelated to the liver. In addition, these tests may be normal in patients who have advanced liver disease.
Several specialized tests have also been developed (such as indocyanine green clearance), which, although uncommonly used in clinical practice, can measure specific aspects of hepatic function.
Despite their limitations, liver biochemical and function tests have many applications in clinical medicine:
●They provide a noninvasive method to screen for the presence of liver disease. The serum aminotransferases, for example, are part of panel of tests used to screen all blood donors in the United States for the presence of transmissible viruses.
●They can be used to measure the efficacy of treatments for liver disease (such as immunosuppressant agents for autoimmune hepatitis). (See "Autoimmune hepatitis: Treatment".)
- Ellis G, Goldberg DM, Spooner RJ, Ward AM. Serum enzyme tests in diseases of the liver and biliary tree. Am J Clin Pathol 1978; 70:248.
- WROBLEWSKI F. The clinical significance of transaminase activities of serum. Am J Med 1959; 27:911.
- ZIMMERMAN HJ, WEST M. SERUM ENZYME LEVELS IN THE DIAGNOSIS OF HEPATIC DISEASE. Am J Gastroenterol 1963; 40:387.
- Kim HY, Kim CW, Lee CD, et al. Can "healthy" normal alanine aminotransferase levels identify the metabolically obese phenotype? Findings from the Korea national health and nutrition examination survey 2008-2010. Dig Dis Sci 2014; 59:1330.
- Siddiqui MS, Sterling RK, Luketic VA, et al. Association between high-normal levels of alanine aminotransferase and risk factors for atherogenesis. Gastroenterology 2013; 145:1271.
- Ruhl CE, Everhart JE. Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology 2005; 128:24.
- Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112:18.
- Boyde TR, Latner AL. Starch gel electrophoresis of transaminase in human tissue extracts and serum. Biochem J 1961; 82:52.
- Rej R. Aspartate aminotransferase activity and isoenzyme proportions in human liver tissues. Clin Chem 1978; 24:1971.
- MORINO Y, KAGAMIYAMA H, WADA H. IMMUNOCHEMICAL DISTINCTION BETWEEN GLUTAMIC-OXALOACETIC TRANSAMINASES FROM THE SOLUBLE AND MITOCHONDRIAL FRACTIONS OF MAMMALIAN TISSUES. J Biol Chem 1964; 239:943.
- Rej R. Measurement of aminotransferases: Part 1. Aspartate aminotransferase. Crit Rev Clin Lab Sci 1984; 21:99.
- Nalpas B, Vassault A, Charpin S, et al. Serum mitochondrial aspartate aminotransferase as a marker of chronic alcoholism: diagnostic value and interpretation in a liver unit. Hepatology 1986; 6:608.
- DUNN M, MARTINS J, REISSMANN KR. The disappearance rate of glutamic oxalacetic transaminase from the circulation and its distribution in the body's fluid compartments and secretions. J Lab Clin Med 1958; 51:259.
- Kamimoto Y, Horiuchi S, Tanase S, Morino Y. Plasma clearance of intravenously injected aspartate aminotransferase isozymes: evidence for preferential uptake by sinusoidal liver cells. Hepatology 1985; 5:367.
- FRANKL HD, MERRITT JH. Enzyme activity in the serum and common duct bile of dogs. Am J Gastroenterol 1959; 31:166.
- Sabath LD, Gerstein DA, Finland M. Serum glutamic oxalacetic transaminase. False elevations during administration of erythromycin. N Engl J Med 1968; 279:1137.
- Cohen GA, Goffinet JA, Donabedian RK, Conn HO. Observations on decreased serum glutamic oxalacetic transaminase (SGOT) activity in azotemic patients. Ann Intern Med 1976; 84:275.
- Vadstrup S. Subnormal alanine aminotransferase values in blood of patients with Crohn disease. Scand J Gastroenterol 2004; 39:554.
- Marshall T, Williams J, Williams KM. Electrophoresis of serum isoenzymes and proteins following acute myocardial infarction. J Chromatogr 1991; 569:323.
- Smit MJ, Duursma AM, Bouma JM, Gruber M. Receptor-mediated endocytosis of lactate dehydrogenase M4 by liver macrophages: a mechanism for elimination of enzymes from plasma. Evidence for competition by creatine kinase MM, adenylate kinase, malate, and alcohol dehydrogenase. J Biol Chem 1987; 262:13020.
- SCHMIDT E, SCHMIDT FW. [Methods and value of determination of glutamic acid dehydrogenase activity in the serum. A contribution to the importance of examination of enzyme relations in the serum]. Klin Wochenschr 1962; 40:962.
- Guder WG, Habicht A, Kleissl J, et al. The diagnostic significance of liver cell inhomogeneity: serum enzymes in patients with central liver necrosis and the distribution of glutamate dehydrogenase in normal human liver. Z Klin Chem Klin Biochem 1975; 13:311.
- Van Waes L, Lieber CS. Glutamate dehydrogenase: a reliable marker of liver cell necrosis in the alcoholic. Br Med J 1977; 2:1508.
- Kaplan MM, et al. Biochemical basis for serum enzyme abnormalities in alcoholic liver disease. In: Early identification of alcohol abuse, Research Monograph No. 17, Chang NC, Chan NM (Eds), NIAAA, 1985. p.186.
- Rosalki, SB. Enzyme tests in disease of the liver and hepatobiliary tract. In: The principles and practice of diagnostic enzymology, Wilkinson JH (Ed), Edward Arnold, London 1973. p.303.
- BELL JL, SHALDON S, BARON DN. Serum isocitrate dehydrogenase in liver disease and some other conditions. Clin Sci 1962; 23:57.
- STERKEL RL, SPENCER JA, WOLFSON SK Jr, WILLIAMS-ASHMAN HG. Serum isocitric dehydrogenase activity with particular reference to liver disease. J Lab Clin Med 1958; 52:176.
- WEST M, SCHWARTZ MA, COHEN J, ZIMMERMAN HJ. SERUM ENZYMES IN DISEASE. XV. GLYCOLYTIC AND OXIDATIVE ENZYMES AND TRANSAMINASES IN PATIENTS WITH CARCINOMA OF THE KIDNEY, PROSTATE AND URINARY BLADDER. Cancer 1964; 17:432.