Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis

Objective To investigate the association of liver function parameters with etiology and severity in patients with acute pancreatitis ( AP) complicated by liver injury, and to clarity the clinical significance of the change in liver function in determining the etiology and severity of AP. Methods A retrospective analysis was performed for the clinical data of 163 AP patients who were hospitalized in Liaocheng People's Hospital from January 2011 to March 2016, and according to the etiology, these patients were divided into biliary AP group with 85 patients and non-biliary AP group with 78 patients. According to the Balthazar CT grade, the patients were divided into mild acute pancreatitis ( MAP) group with 138 patients and severe acute pancreatitis ( SAP) group with 25 patients. Of all patients in the biliary AP group, 18 had biliary SAP and 67 had biliary MAP; of all patients in the non-biliary AP group, 7 had non-biliary SAP and 71 had non-biliary MAP. The groups were compared in terms of liver function parameters alanine aminotransferase ( ALP) , aspartate aminotransferase ( AST) , gamma-glutamyl transpeptidase ( GGT) , and alkaline phosphatase ( ALP) , and the change in liver function was observed on admission and at 48 and 96 hours after admission. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between three groups, and the SNK-q test was sued for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results In the patients with MAP, there were significant differences in the levels of ALT, AST, ALP, and GGT between the biliary AP group and the non-biliary AP group ( all P < 0. 05) ; in the patients with SAP, there were only significant differences in the levels of ALP and GGT between the biliary AP group and the non-biliary AP group ( both P<0. 05) . As for liver injury caused by biliary AP, there were significant reductions in the levels of ALT, AST, ALP, and GGT at 48-96 hours after admission ( all P < 0. 05) , while in the patients with non-biliary AP, there were no significant changes in these liver function parameters ( all P >0. 05) . Compared with the non-biliary AP group, the biliary AP group had a significantly higher incidence rate of an abnormal level of ALP, GGT, or ALP + GGT ( all P < 0. 05) . In the patients with AP caused by the same reason, there was no significant difference in liver function between SAP and MAP patients ( all P > 0. 05) . Conclusion Most patients with AP tend to have abnormal liver function, especially those with biliary AP. As for patients with MAP, abnormal liver function often indicates biliary AP; as for patients with SAP, ALT and AST have a low value in predicting etiology, while ALP and GGT are more sensitive, i. e., the increase in ALT and GGT indicates the possibility of biliary AP. When the change in liver function is monitored continuously, the patients with significant reductions in liver function parameters, especially the levels of ALT and AST, tend to have a higher possibility of biliary AP. The degree of liver injury, especially the activities of aminotransferases, is not associated with the severity of AP.