title: Prognostic value of biochemical liver parameters in neonatal sepsis-associated cholestasis.
abstract: OBJECTIVE
  The aim of the study was to evaluate the significance of total bilirubin, aspartate transaminase (AST), alanine transaminase and gamma-glutamyltransferase (GGT) for predicting outcome in sepsis-associated cholestasis.
  
  
  METHODS
  A retrospective cohort review of the hospital records was performed in 181 neonates admitted to the Neonatal Care Unit. A comparison was performed between subjects with low and high liver values based on cut-off values from ROC analysis. We defined poor prognosis to be when a subject had prolonged cholestasis of more than 3.5 months, developed severe sepsis, septic shock or had a fatal outcome.
  
  
  RESULTS
  The majority of the subjects were male (56%), preterm (56%) and had early onset sepsis (73%). The poor prognosis group had lower initial values of GGT compared with the good prognosis group (P = 0.003). Serum GGT (cut-off value of 85.5 U/L) and AST (cut-off value of 51 U/L) showed significant correlation with the outcome following multivariate analysis. The odds ratio (OR) of low GGT and high AST were OR 4.3 (95% CI:1.6 to 11.8) and OR 2.9 (95% CI:1.1 to 8), respectively, for poor prognosis. In subjects with normal AST values, those with low GGT value had relative risk of 2.52 (95% CI:1.4 to 3.5) for poorer prognosis compared with those with normal or high GGT.
  
  
  CONCLUSIONS
  Serum GGT and AST values can be used to predict the prognosis of patients with sepsis-associated cholestasis.
authors.affiliation: Division of Gastrohepatology, Department of Child Health, Medical School, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. hoswari@gmail.com
authors.forename: Hanifah
authors.initials: H
authors.lastname: Oswari
authors.forename: Ruth Karisma
authors.initials: RK
authors.lastname: Widjaja
authors.forename: Rinawati
authors.initials: R
authors.lastname: Rohsiswatmo
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cleghorn
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000401:mortality; D012720:Severity of Illness Index; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin