{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:44:11Z","timestamp":1782603851051,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,7,18]],"date-time":"2019-07-18T00:00:00Z","timestamp":1563408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Marked elevations of alanine aminotransferase (ALT) are caused by a limited number of underlying pathologies, including hepatic ischemia, drugs\/toxins, viral hepatitis, and\u2014rarely\u2014autoimmune hepatitis. The aim of this study was to determine the relative incidence of pathologies resulting in ALT greater than 1000\u2009IU\/L and factors predicting clinical outcomes in an Australian cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study of all adult patients with ALT levels greater than 1000\u2009IU\/L between January 2013 and December 2015 was conducted at a large teaching hospital network in Australia. Multivariable logistic regression analysis was used to determine predictors of etiology and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 287 patients identified with ALT levels greater than 1000\u2009IU\/L. The most common causes were ischemia (44%), drugs\/toxins (19%), biliary obstruction (16%), and viral hepatitis (7%). Independent predictors of a diagnosis of ischemic hepatitis included (adjusted odds ratio; 95% confidence interval): hypotension (29.2; 8.2\u2013104.7), chronic obstructive pulmonary disease (COPD) (20.2; 2.8\u2013145.3), coronary artery disease (12.9; 1.7\u201398.9), congestive cardiac failure (7.8; 1.2\u201349.2), diabetes mellitus (7.4; 1.6\u201333.9), metabolic acidosis (6.2; 2.0\u201319.4), gamma\u2010glutamyltransferase\u2009&lt;\u2009135\u2009IU\/L (5.1; 1.5\u201317.6), and albumin &lt;34\u2009g\/L (3.4; 1.1\u201311.0). Independent risk factors for all\u2010cause 28\u2010day mortality included: septic shock (14.7; 4.3\u201350.7), metabolic acidosis (7.3; 2.5\u201321.3), history of COPD (5.4; 1.6\u201317.8), cardiogenic shock (4.3; 1.6\u201311.7), prothrombin time\u2009\u2265\u200920\u2009s (3.7; 1.5\u20139.2), and age\u2009\u2265\u200965\u2009years (3.0; 1.3\u20137.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ischemic hepatitis was the most common cause of ALT levels greater than 1000\u2009IU\/L and was associated with high mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12224","type":"journal-article","created":{"date-parts":[[2019,7,18]],"date-time":"2019-07-18T15:23:22Z","timestamp":1563463402000},"page":"106-112","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Epidemiology and outcomes of marked elevations of alanine aminotransferase &gt;1000 IU\/L in an Australian cohort"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4983-6103","authenticated-orcid":false,"given":"Danny","family":"Con","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Eastern Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Buckle","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J","family":"Nicoll","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Health  Melbourne Victoria Australia"},{"name":"Eastern Health Clinical School Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S","family":"Lubel","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School Monash University  Melbourne Victoria Australia"},{"name":"Central Clinical School Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,18]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/46.12.2027"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1991.00400020036008"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-137-1-200207020-00006"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2012.07143.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.131"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1040752"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.07.033"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12323"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.15-3-244"},{"key":"e_1_2_5_11_1","first-page":"1244","article-title":"Extreme serum elevations of aspartate aminotransferase","volume":"90","author":"Johnson RD","year":"1995","journal-title":"Am. J. Gastroenterol."},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.45.1.129"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90101-6"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90102-7"},{"key":"e_1_2_5_15_1","first-page":"213","article-title":"An intuitive approach to receiver operating characteristic curve analysis","volume":"19","author":"Turner DA","year":"1978","journal-title":"J. Nucl. Med."},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(00)00115-X"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1157\/13070378"},{"key":"e_1_2_5_18_1","first-page":"271","article-title":"Marked hypertransaminasemia incidence in a health department in the autonomous community of Valencia, Spain (2002\u20102003)","volume":"81","author":"Castillo\u2010Gomez E","year":"2007","journal-title":"Rev. Esp. Salud Publica"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.08.016"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2008.11.002"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005176"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000608"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/2324709616651092"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2015.1121516"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i41.5972"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-010-1058-3"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-009-1508-2"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2017.04.040"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v9.i22.959"}],"container-title":["JGH Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12224","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgh3.12224","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.12224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T09:35:46Z","timestamp":1694079346000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgh3.12224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,18]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1002\/jgh3.12224"],"URL":"https:\/\/doi.org\/10.1002\/jgh3.12224","archive":["Portico"],"relation":{},"ISSN":["2397-9070","2397-9070"],"issn-type":[{"value":"2397-9070","type":"print"},{"value":"2397-9070","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,18]]},"assertion":[{"value":"2019-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}