LAUSR

Around 25% to 50% of lupus patients may present with alterations in the liver enzymes of variable severity including fulminant hepatic failure.1To study the prevalence, aetiology and the outcome in lupus patients hospitalized with liver enzyme abnormalities.We analysed liver enzymes of all hospitalized lupus patients from June 2018–June 2021. Patients with abnormal liver enzymes(>2 times Upper Limit Normal)2 were identified and categorized as per the standard definitions/criteria.3,4 The outcomes and association of liver enzymes to mortality was analysed.Liver enzymes were available in 461/535 hospitalisations amongst 383 lupus patients of whom abnormalities were detected in 95/461 (20.6%). Among 77 patients with elevated transaminases, 33/77(42.9%) fulfilled criteria for macrophage activation syndrome (MAS) as per HLH criteria and parodie et.al4. Other aetiologies are represented in Table 1. Overall the mortality rate was 12/77(15.58%), highest being MAS 9/12(75%). Higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio was associated with adverse outcomes in patients with MAS.Table 1.Aetiology and associations of liver enzyme abnormalitiesAetiologies for elevated transaminasesMacrophage activation syndrome33/77(42.9%)Lupus activity16/77(20.8%)Overlap Myositis12/77(15.6%)Autoimmune Hepatitis6/77(7.8%)Sepsis5/77(6.5%)Primary Biliary Cirrhosis3/77(3.9%)Drugs2/77(2.6%)Comparison between patients with and without MASComparison between patients with and without mortality among MAS patientsMAS (N=33)No MAS (N=44)P-valueMortality (N= 9/33)No Mortality (N=24/33)P-valueAST228(169,377.5)(128,281)0.098 *265(232.5,545)209(139.5,360)0.036*ALT73(51.5,121.5)96(54,140)0.52058(46,132.5)94.5(53.5,121.75)0.505ALP202(69.5,382.5)175(90,318)0.794233.5(84,382.2)202(69.5,407.5)0.788GGT232(77.5, 443)179(75,333)0.312402(139.5,995.7)202(70.5,373.0)0.205AST/ALT RATIO3.18(1.96,4.45)2.3(1.4,3.6)0.016*4.33(3.07,6.66)2.58(1.94,3.64)0.032*ABBREVATIONS- AST- Aspartate aminotransferase; ALT- Alanine aminotransferase; ALP- Alkaline phosphatase, GGT- Gamma glutamyl transferase. Statistically significant *P-value = < 0.05.MAS was the most frequent cause of elevated transaminases and was associated with mortality in subset with higher AST/ALT ratio.[1]Chowdhary VR, Crowson CS, Poterucha JJ, Moder KG. Liver involvement in systemic lupus erythematosus: case review of 40 patients. The Journal of Rheumatology. 2008 Nov 1;35(11):2159-64.[2]Her M, Lee Y, Jung E, Kim T, Kim D. Liver enzyme abnormalities in systemic lupus erythematosus: a focus on toxic hepatitis. Rheumatology international. 2011 Jan;31(1):79-84.1.[3]Henter JI, Horne A, Aricó M, Egeler RM, etal. HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatric blood & cancer. 2007 Feb;48(2):124-31.[4]Parodi A, Davì S, Pringe AB, Pistorio A, etal. Macrophage activation syndrome in juvenile systemic lupus erythematosus: a multinational multicenter study of thirty-eight patients. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2009 Nov;60(11):3388-99.None declared