PROGNOSTIC AND THERAPEUTIC IMPLICATIONS OF EXTREME SERUM AMINOTRANSFERASE ELEVATION IN CHRONIC ACTIVE HEPATITIS

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  • 1 January 1982
    • journal article
    • research article
    • Vol. 57  (5) , 303-309
Abstract
Extreme elevation of the serum aspartate aminotransferase level typically suggest acute hepatocellular necrosis and may militate against the diagnosis of chronic active hepatitis. However, 26 of 160 patients (16%) with chronic active hepatitis apparently had aminotransferase elevations of > 1000 IU/l. These patients were younger and more often jaundiced than the others, but they exhibited signs of chronic liver disease as often. In only 2 of 26 patients with extreme aminotransferase abnormality were features of chronic disease absent. Patients with extreme enzyme elevation had histologic findings of confluent necrosis (P < 0.005) and features associated with acute viral infection (P < 0.005) more often than others, but they as often had cirrhosis on biopsy specimens. Virologic markers did not distinguish the patients or correlate with viral features in liver tissue. Corticosteroids improved immediate survival (P < 0.005) and the likelihood of remission (P < 0.005). Although chronic active hepatitis may present with extreme aminotransferase elevation and histologic features associated with acute viral infection, ancillary features of chronic disease facilitate the correct diagnosis and the initiation of appropriate therapy.

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