title: To biopsy or not to biopsy: evaluation of a large German cohort of patients with abnormal liver tests of unknown etiology.
abstract: OBJECTIVE
  Despite increasingly sensitive and accurate blood tests to detect liver disease, liver biopsy remains very useful in patients with atypical clinical features and abnormal liver tests of unknown etiology. The aim was to determine those elevated laboratory liver parameters that cause the clinician to order a biopsy, and whether laboratory tests are associated with pathological findings on histology.
  
  
  METHODS
  504 patients with unclear hepatopathy, admitted to the outpatient clinic of a university hospital between 2007 and 2010, were analyzed with respect to laboratory results, clinical data, and the results of liver biopsies.
  
  
  RESULTS
  Aspartate aminotransferase (AST) and glutamate dehydrogenase (GLDH) levels above the normal range significantly increased the likelihood of recommending a liver biopsy by 81% [OR with 95% CI 1.81 (1.21-2.71), p = 0.004] and 159% [OR with 95% CI 2.59 (1.70-3.93), p < 0.001], respectively. AST values above normal were associated with fibrosis (63 vs. 40% for normal AST, p = 0.010). Elevated ferritin levels pointed to a higher incidence of steatosis (48 vs. 10% for normal ferritin, p < 0.001) and inflammation (87 vs. 62% for normal ferritin, p = 0.004).
  
  
  CONCLUSIONS
  Our results indicate that elevated AST and GLDH were associated with a greater likelihood of recommending liver biopsy. Elevated AST and ferritin levels were associated with steatosis, inflammation and fibrosis on liver biopsies. Thus, AST and ferritin may be useful non-invasive predictors of liver pathology in patients with unclear hepatopathy.
authors: First Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany.
authors: Johannes Wilhelm
authors: JW
authors: Rey
authors: Antje
authors: A
authors: Jahn-Eimermacher
authors: Veronika
authors: V
authors: Doernberger
authors: Ana Paula
authors: AP
authors: Barreiros
authors: Markus
authors: M
authors: Krupp
authors: Arthur
authors: A
authors: Hoffman
authors: Ralf
authors: R
authors: Kiesslich
authors: Martina
authors: M
authors: Müller-Schilling
authors: Peter Robert
authors: PR
authors: Galle
authors: Andreas
authors: A
authors: Teufel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005858:Germany; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis* / Q000201:enzymology; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult