Korean J Gastroenterol.  2019 Oct;74(4):205-211. 10.4166/kjg.2019.74.4.205.

Serum Aminotransferase Level in Rhabdomyolysis according to Concurrent Liver Disease

• Jo KM
• Heo NY
• Park SH
• Moon YS
• Kim TO
• Park J
• Choi JH
• Park YE
• Lee J

• KMID: 2460985
• DOI: http://doi.org/10.4166/kjg.2019.74.4.205

Abstract

BACKGROUND/AIMS
The serum aminotransferase level is usually elevated in rhabdomyolysis, and these enzymes originate from the skeletal muscle. On the other hand, there is limited data showing whether the degree of elevation of these enzymes differs according to the concurrent liver disease.
METHODS
Patients with rhabdomyolysis were selected when their serum creatinine kinase level was >1,000 U/L. They were categorized as the group with and without concurrent liver disease. The AST and ALT levels in both groups were compared. In addition, the aminotransferase level was compared between those with rhabdomyolysis and those with alcoholic liver disease.
RESULTS
Among the 165 patients with rhabdomyolysis, 19 had concurrent liver disease. The median peak AST was higher in the group with concurrent liver disease (332 U/L [interquartile range (IQR), 127-1,604] vs. 219 U/L [IQR, 115-504]). In addition, the median peak ALT was higher in the group with concurrent liver disease (107 U/L [IQR, 74-418] vs. 101 U/L [IQR, 56-218]). On the other hand, there was no significant difference in both enzymes between the two groups. The median peak AST level was significantly higher in those with rhabdomyolysis than in those with alcoholic liver disease (221 U/L [IQR, 118-553] vs. 103 U/L [IQR, 59-206]), but the median peak ALT was not significantly different (102 U/L [IQR, 58-222] vs. 51 U/L [IQR, 26-117]).
CONCLUSIONS
Rhabdomyolysis showed an elevated AST-dominant aminotransferase level, which is not different according to concurrent liver disease. Therefore, it is recommended that rhabdomyolysis be considered first in cases of elevated aminotransferase levels in patients with a suspicious skeletal muscle injury.

Keyword

Rhabdomyolysis; Aspartate aminotransferases; Alanine transaminase; Liver diseases

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
Creatinine
Hand
Humans
Liver Diseases*
Liver Diseases, Alcoholic
Liver*
Muscle, Skeletal
Phosphotransferases
Rhabdomyolysis*
Alanine Transaminase
Aspartate Aminotransferases
Creatinine
Phosphotransferases

Figure

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  Fig. 1 Flowchart of the enrollment of patients with rhabdomyolysis. KCD, Korean Standard Classification of Diseases; CK, creatinine kinase.

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  Fig. 2 Cause of rhabdomyolysis.

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  Fig. 3 Distribution of serum AST and ALT in the patients with rhabdomyolysis according to the presence of liver disease. Seven and two outliers of serum AST over 2,000 U/L in the patients with or without liver disease were omitted, respectively. Two outliers of serum ALT over 2,000 U/L in those without liver disease were omitted in this graph. The mean and median value of each variable was described as a red triangle and black thick horizontal bar in the box respectively. AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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  Fig. 4 Laboratory findings over time in the index case with rhabdomyolysis and hepatitis B virus infection. AST, aspartate aminotransferase; ALT, alanine aminotransferase; CK, creatinine kinase; ETV, entecavir; D, day; Mo, month; Yr, year.

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