Exploring Viral and Non-Viral causes of Alanine Aminotransferase Spikes above 1000 in a South Asian Cohort
DOI:
https://doi.org/10.63521/pjg.41.4.2025.18Abstract
ABSTRACT
Background
Elevated ALT levels greater than 1000 U/L indicate severe hepatic injury. In Western studies, ischemic hepatitis and drug-induced liver injury (DILI) are common causes (1, 2). However, in South Asia, hepatitis E (HEV) predominates, contributing to a different clinical pattern. This study explores the causes and outcomes of ALT >1000 U/L in a South Asian cohort.
Methods
we prospectively analyzed 151 patients with ALT >1000 U/L from AIMS Hospital. Data on demographics, etiology, clinical presentation (acute hepatitis, acute liver failure [ALF], acute-on-chronic liver failure [ACLF]), hospital stay, and 30-day outcomes were collected. Statistical analysis was performed using IBM SPSS Version 22.
Results
Viral hepatitis was the leading cause (86.1%), with hepatitis E being the most frequent (55.6%). Non-viral causes, including ischemic hepatitis (4.6%) and DILI (3.3%), were rare. Acute hepatitis (63.6%) was the most common presentation, and hepatitis E was responsible for 63.5% of these cases. ALF occurred in 11.9%, primarily due to hepatitis E. The majority of patients (78.1%) had a short hospital stay (<48 hours), with 94% showing improvement. Severe cases (ischemic hepatitis, ACLF) resulted in a 4% mortality rate, and 2% were referred for liver transplantation.
Conclusion
Our study highlights the dominance of hepatitis E in ALT >1000 U/L in South Asia, contrasting with Western trends where ischemic hepatitis and DILI are more prevalent (1, 2). These findings suggest the need for regional-specific diagnostic strategies, particularly in endemic areas.
References:
- Mohamed MF, Wadhavkar N, Elfanagely Y, Marino D, Beran A, Abdallah M, Promrat K. Etiologies and Outcomes of Transaminase Elevation > 1000 IU/L: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2023 Jul;68(7):2843-2852. doi: 10.1007/s10620-023-07962-w. Epub 2023 May 15. PMID: 37184617.
- Breu AC, Patwardhan VR, Nayor J, Ringwala JN, Devore ZG, Ganatra RB, Hathorn KE, Horton L, Iriana S, Tapper EB. A Multicenter Study Into Causes of Severe Acute Liver Injury. ClinGastroenterolHepatol. 2019 May;17(6):1201-1203. doi: 10.1016/j.cgh.2018.08.016. Epub 2018 Aug 10. PMID: 30103039.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Sadik Memon (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the Pakistan Journal of Gastroenterology (PJG) the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
