Random urine bile acids in prediction of liver abnormality in asymptomatic alcoholics

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Abstract
• We evaluated bile acids for prediction of abnormal serum liver profile in a random sample of urine (URNBA). Seventy-four subjects with excessive alcohol intake, self-referred for outpatient detoxification, had no history or physical findings of liver disease. Surprisingly, in 49% (36/74) of alcoholics, two or more of these were elevated: serum bile acids, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase (ALP), and/or total bilirubin. All subjects were subdivided into 39 URNBA normal and 35 URNBA abnormal, using 2.6 μmol/g of creatinine as a dividing value. Serum tests confirmed the subgrouping made with URNBA. Compared with alanine aminotransferase, URNBA had better sensitivity, specificity, and overall diagnostic accuracy predicting abnormal serum bile acids, AST, and alkaline phosphatase values. A predictive potential for a multivariate discriminant function of laboratory tests, known to best identify biopsy-documented mild liver disease, was only mildly inferior for URNBA when compared with AST. Multiple abnormalities of liver test results are unexpectedly frequent in asymptomatic alcoholics. The URNBA are helpful in the detection of liver abnormality In its clinically latent phase, because of the convenience of testing a spot sample of urine. (Arch Intern Med1988;148:312-315)