Extreme serum elevations of aspartate aminotransferase.
OBJECTIVE
To determine the frequency, etiology, and associated mortality of extreme elevations of serum AST.


METHODS
The medical records were reviewed of all patients with a serum AST over 3000 U/L during 1 full calendar year at a large, tertiary-care hospital. Serum AST, with an upper limit of normal at 35 U/L, is included in the automated, 18-test chemistry profile run on virtually all clinically ill patients admitted to this hospital.


RESULTS
Of 23,125 admissions, 56 patients had or developed serum AST concentrations greater than 3000 U/L, an occurrence rate of approximately two per 1000 admissions. Either liver or skeletal muscle was the origin of virtually all such AST elevations. Acute hypotension (ischemic or hypoxic hepatitis) accounted for the majority (29/56) of the cases; toxic (seven) or viral (four) hepatitis together accounted for 11/56 cases. Overall mortality, on this admission, was 31/56 (55%).


CONCLUSIONS
Extreme elevations of AST are most often attributable to hypoxic hepatitis. Patients with extreme AST due to hypoxic hepatitis had a 22/29 (75%) mortality compared with 9/27 (33%) for all other causes combined.
Johnson
R D
RD
Department of Pathology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
O'Connor
M L
ML
Kerr
R M
RM
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000208:Acute Disease; D001219:Aspartate Aminotransferases / Q000097:blood*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000401:mortality; D004796:Clinical Enzyme Tests; D002984:Clinical Laboratory Information Systems; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D012016:Reference Values; D012769:Shock / Q000175:diagnosis / Q000401:mortality
D001219:Aspartate Aminotransferases