Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis.
OBJECTIVE
To evaluate the hepatic dysfunction in leptospirosis is usually mild and resolved eventually. However, sequential follow-up of liver biochemical data remained lacking..


METHODS
The biochemistry data and clinical symptoms of 11 sporadic patients were collected and analyzed, focusing on the impacts of leptospirosis upon liver biochemistry tests.


RESULTS
The results disclosed that of the 11 cases, 5 or 45% died. The liver biochemistry data in the beginning of the disease course were only mildly elevated. Nevertheless, late exaggerated aspartate transaminase (AST) elevations were noted in three cases who finally died when compared with the typical course. Besides, significant higher AST/alanine transaminase (ALT) ratios (AARs) of the peak levels for transaminase were also noted in the cases who eventually succumbed. The mean+/-SD of AARs for the survival group and dead group were 5.65+/-2.27 (n = 5) and 1.86+/-0.64 (n = 6) respectively (P = 0.006). The ratios of the cases who finally died were all more than 3.0. Conversely, the survival group's ratios were less than 3.0.


CONCLUSIONS
Serial follow-up of transaminase might provide evidence to predict some rare evolutions in leptospirosis. If AST elevated progressively without a concomitant change of ALT, it might indicate an acute disease course with ensuing death. Additionally, AAR is another prognostic parameter for leptospirosis. Once the value was higher than 3.0, a grave prognosis is inevitable.
Chang
Ming-Ling
ML
Department of Hepatogastr-oenterology, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, China.
Yang
Chih-Wei
CW
Chen
Jeng-Chang
JC
Ho
Yu-Pin
YP
Pan
Ming-Jeng
MJ
Lin
Cheng-Hui
CH
Lin
Deng-Yn
DY
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000201:enzymology* / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000201:enzymology / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D013997:Time Factors
D001219:Aspartate Aminotransferases