Levels and initial course of serum alanine aminotransferase can predict outcome of patients with Budd-Chiari syndrome.
OBJECTIVE
Patients with Budd-Chiari syndrome can present with acute, subacute, or chronic disease; the definitions and significance of these variants have been disputed. An increased level of serum alanine aminotransferase (ALT) is an objective marker for acute liver injury. We analyzed the significance of changes in ALT levels in Budd-Chiari syndrome patients.


METHODS
We performed a retrospective analysis of data from 96 consecutive Budd-Chiari syndrome patients.


RESULTS
A threshold peak ALT level that was 5-fold the upper limit of normal distinguished 2 groups of patients: patients with high levels of ALT (40% of patients) presented with more severe liver disease, less frequent liver fibrosis, and more frequent liver cell necrosis, compared with those with ALT levels below this threshold. Patients with levels of ALT that started out high but slowly declined (<50% of starting concentration within 3 days) had significantly lower odds of survival than those with a rapid decline and those with low levels of ALT (40 months transplantation-free survival, 31%, 63%, and 71%, respectively). When ALT level and the velocity of its decline are used as criterion, these data add significant prognostic information to Child-Pugh, to Clichy, and to Rotterdam Budd-Chiari syndrome scores.


CONCLUSIONS
Determination of ALT levels at patient presentation allows 2 variants of Budd-Chiari syndrome to be distinguished. High levels of ALT reflect acute, severe, but potentially reversible, ischemic liver cell necrosis. High levels of ALT that decrease slowly predict a poor outcome for patients and might justify rapid aggressive management.
Rautou
Pierre-Emmanuel
PE
Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France.
Moucari
Rami
R
Cazals-Hatem
Dominique
D
Escolano
Sylvie
S
Denié
Cécile
C
Douarin
Ludivine
L
Francoz
Claire
C
Durand
François
F
Ozenne
Violaine
V
Imbert
Audrey
A
Moreau
Richard
R
Lebrec
Didier
D
Plessier
Aurélie
A
Valla
Dominique
D
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D006502:Budd-Chiari Syndrome / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D044967:Serum / Q000737:chemistry; D016019:Survival Analysis; D013997:Time Factors
D000410:Alanine Transaminase