title: [Hypertransaminasemia greater than 400 U/l in adults seen at a tertiary hospital. Prospective study of etiology].
abstract: OBJECTIVE
  To investigate the frequency of distinct causes of elevated transaminase levels in the range of acute viral hepatitides in patients attended in a hospital.
  
  
  METHODS
  Patients attended in a tertiary hospital over a 3-month period who had elevation of transaminase levels (aspartate aminotransferase [AST] or alanine aminotransferase [ALT]) above 400 U/l were identified and their medical records were reviewed to determine etiology.
  
  
  RESULTS
  A total of 106 patients were studied, of which 22 had undergone liver transplantation. In these patients, the causes of hypertransaminasemia were ischemic/reperfusion injury in 6 (27%), ischemic hepatitis in 4 (18%), acute hepatitis in 2 (9%), cellular rejection in 3 (14%), chronic hepatitis C in 4 (18%) and cholestasis in 3 (14%). In the 84 patients who did not undergo transplantation, the causes were hepatic ischemia in 24 (28%), chronic viral hepatitis in 19 (22%), toxic hepatitis in 12 (14%), pancreatico-biliary disease in 11 (13%), acute viral or bacterial hepatitis in 10 (12%), liver tumor in 3 (4%), cholestasis of pregnancy in one and unknown in 4 (5%). Ischemic lesions and pancreatico-biliary disease were more frequent in hospitalized patients while acute and chronic hepatitides were more frequent in outpatients. The worst outcomes were found in ischemic lesions and pancreatico-biliary disease.
  
  
  CONCLUSIONS
  Marked elevation of transaminase levels has multiple causes. Acute viral hepatitides were a relatively infrequent cause. In transplant recipients, the most frequent causes were ischemia/reperfusion injury, while in non-transplanted patients the most frequent causes were ischemic hepatitides and acute episodes of chronic viral hepatitides. The AST/ALT ratio did not contribute to etiologic diagnosis.
authors.affiliation: Servicio de Hepatología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain. bruguera@clinic.ub.es
authors.forename: M
authors.initials: M
authors.lastname: Bruguera
authors.forename: J M
authors.initials: JM
authors.lastname: Barrera
authors.forename: F
authors.initials: F
authors.lastname: Corradi
authors.forename: A
authors.initials: A
authors.lastname: Mas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000637:Transaminases / Q000097:blood*
chemical_list: D000637:Transaminases