title: Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis.
abstract: 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.
authors.affiliation: Department of Hepatogastr-oenterology, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, China.
authors.forename: Ming-Ling
authors.initials: ML
authors.lastname: Chang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Jeng-Chang
authors.initials: JC
authors.lastname: Chen
authors.forename: Yu-Pin
authors.initials: YP
authors.lastname: Ho
authors.forename: Ming-Jeng
authors.initials: MJ
authors.lastname: Pan
authors.forename: Cheng-Hui
authors.initials: CH
authors.lastname: Lin
authors.forename: Deng-Yn
authors.initials: DY
authors.lastname: Lin
mesh_terms: 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
chemical_list: D001219:Aspartate Aminotransferases