Abstract：
Among liver injury causes, few result in marked elevation of liver enzymes to a level > 1,000 international units per liter (IU/L). This review summarizes common etiologies of marked transaminase elevation and associated prognostic factors.
We performed a comprehensive search on PubMed, EMBASE, Cochrane Library, and Google Scholar from inception through December 2022 using MOOSE guidelines for studies reporting frequency of etiologies of marked transaminase elevation. We used a proportion meta-analysis to pool frequencies with corresponding 95% confidence interval (CI). I2 was used to adjudicate heterogeneity. We used CMA software for statistical analysis.
Seven relevant studies (n = 1608 patients) were included. The pooled frequency of ischemic hepatitis was 51% (95% CI 42-60%, I2 = 91%), viral hepatitis was 13.1% (95% CI 9.7-17.6%, I2 = 80%), toxins or drug-induced liver injury (DILI) was 13% (95% CI 8-18%, I2 = 85%), and pancreaticobiliary-related injury was 7.8% (95% CI 4.4-13.6%, I2 = 89%). Mortality was significantly higher in ischemic hepatitis versus other causes of marked transaminase elevation, with an odds ratio of 21 (95% CI 9.9-44.8, P value < 0.0001, I2 = 64% Q 11.1).
This is the first meta-analysis to examine etiologies of marked transaminase elevation > 1000 IU/L. Liver ischemia is the most common cause, while other causes include DILI or toxins, viral hepatitis, and biliary pathologies. We found biliary pathologies to be the fourth most common cause. This is clinically relevant as it has been traditionally linked to a cholestatic pattern of liver injury. Being aware of this presentation may help prevent delayed or missed diagnoses and unnecessary testing.
We performed a comprehensive search on PubMed, EMBASE, Cochrane Library, and Google Scholar from inception through December 2022 using MOOSE guidelines for studies reporting frequency of etiologies of marked transaminase elevation. We used a proportion meta-analysis to pool frequencies with corresponding 95% confidence interval (CI). I2 was used to adjudicate heterogeneity. We used CMA software for statistical analysis.
Seven relevant studies (n = 1608 patients) were included. The pooled frequency of ischemic hepatitis was 51% (95% CI 42-60%, I2 = 91%), viral hepatitis was 13.1% (95% CI 9.7-17.6%, I2 = 80%), toxins or drug-induced liver injury (DILI) was 13% (95% CI 8-18%, I2 = 85%), and pancreaticobiliary-related injury was 7.8% (95% CI 4.4-13.6%, I2 = 89%). Mortality was significantly higher in ischemic hepatitis versus other causes of marked transaminase elevation, with an odds ratio of 21 (95% CI 9.9-44.8, P value < 0.0001, I2 = 64% Q 11.1).
This is the first meta-analysis to examine etiologies of marked transaminase elevation > 1000 IU/L. Liver ischemia is the most common cause, while other causes include DILI or toxins, viral hepatitis, and biliary pathologies. We found biliary pathologies to be the fourth most common cause. This is clinically relevant as it has been traditionally linked to a cholestatic pattern of liver injury. Being aware of this presentation may help prevent delayed or missed diagnoses and unnecessary testing.
摘要：
背景：在肝损伤原因中，很少导致肝酶显著升高至>1,000国际单位/升(IU/L)的水平。这篇综述总结了转氨酶明显升高的常见病因和相关的预后因素。
方法：我们对PubMed进行了全面搜索，EMBASE,科克伦图书馆,和谷歌学者从成立到2022年12月，使用MOOSE指南报告显著转氨酶升高的病因频率的研究。我们使用比例荟萃分析汇集频率和相应的95%置信区间(CI)。I2用于判定异质性。采用CMA软件进行统计分析。
结果：纳入7项相关研究（n=1608例）。缺血性肝炎的合并频率为51％（95％CI42-60％，I2=91%)，病毒性肝炎为13.1％（95％CI9.7-17.6％，I2=80%)，毒素或药物性肝损伤（DILI）为13%（95%CI8-18%，I2=85%)，胰胆管相关损伤为7.8%(95%CI4.4-13.6%,I2=89%)。缺血性肝炎的死亡率明显高于其他原因的转氨酶明显升高，比值比为21(95%CI9.9-44.8，P值<0.0001，I2=64%Q11.1)。
结论：这是第一个检查转氨酶显著升高>1000IU/L的病因的荟萃分析。肝脏缺血是最常见的原因，而其他原因包括DILI或毒素，病毒性肝炎,和胆道病变。我们发现胆道病变是第四大常见原因。这是临床相关的，因为它传统上与胆汁淤积型肝损伤有关。了解此演示文稿可能有助于防止延迟或错过诊断和不必要的测试。
方法：我们对PubMed进行了全面搜索，EMBASE,科克伦图书馆,和谷歌学者从成立到2022年12月，使用MOOSE指南报告显著转氨酶升高的病因频率的研究。我们使用比例荟萃分析汇集频率和相应的95%置信区间(CI)。I2用于判定异质性。采用CMA软件进行统计分析。
结果：纳入7项相关研究（n=1608例）。缺血性肝炎的合并频率为51％（95％CI42-60％，I2=91%)，病毒性肝炎为13.1％（95％CI9.7-17.6％，I2=80%)，毒素或药物性肝损伤（DILI）为13%（95%CI8-18%，I2=85%)，胰胆管相关损伤为7.8%(95%CI4.4-13.6%,I2=89%)。缺血性肝炎的死亡率明显高于其他原因的转氨酶明显升高，比值比为21(95%CI9.9-44.8，P值<0.0001，I2=64%Q11.1)。
结论：这是第一个检查转氨酶显著升高>1000IU/L的病因的荟萃分析。肝脏缺血是最常见的原因，而其他原因包括DILI或毒素，病毒性肝炎,和胆道病变。我们发现胆道病变是第四大常见原因。这是临床相关的，因为它传统上与胆汁淤积型肝损伤有关。了解此演示文稿可能有助于防止延迟或错过诊断和不必要的测试。
