Is Transaminitis Life-Threatening?

Liver disease is always a cause for concern even if there are no obvious symptoms in some cases and the early stages of progressive diseases.

Mild to moderate elevations in liver enzymes may cause the following symptoms:

• Fatigue
• Fever
• Nausea and vomiting
• Upper right quadrant abdominal pain and tenderness
• Mental changes
• Loss of appetite
• The yellow color of the skin or whites of the eyes (jaundice)
• Urine that is dark or looks like tea
• Stool that is light in color
• Itching

Higher levels of alanine transaminase (ALT) than aspartate transaminase (AST) are found in most types of liver diseases.

Extremely high levels of AST (more than 10 times the normal level) are usually caused by:

• Acute hepatitis or, sometimes, a viral infection: In acute hepatitis, AST levels typically remain elevated for one to two months but can take up to three to six months to return to normal.
• AST levels can be significantly elevated (often more than 100 times the normal) as a result of exposure to toxic drugs or other substances, as well as conditions that cause decreased blood flow (ischemia) to the liver.
• AST levels are typically lower in chronic hepatitis, often less than four times the normal, and are more likely to be normal than ALT levels. With chronic hepatitis, AST frequently varies between normal and slightly elevated, so the test may be ordered regularly to determine the pattern.
• Moderate increases could be seen in other liver diseases, particularly when the bile ducts are blocked, such as cirrhosis or certain liver cancers.
• AST can rise after a heart attack or a muscle injury, and it is usually higher than ALT.

AST and ALT ratio

• In most liver diseases, it is usually low (less than one).
• In alcoholic hepatitis, cirrhosis, or injury from bile duct obstruction, the AST and ALT ratio is usually elevated.
• When there is a heart or muscle injury, AST levels are often much higher than ALT (often three to five times higher) and levels tend to stay higher than ALT for a longer period than when there is a liver injury.

Because transaminitis is not a disease, there is no treatment pattern for it. It is a good diagnostic for the success of treatments aimed at reversing the underlying diseases. 

Transaminitis treatment will vary depending on the cause but may include:

• Abstaining from alcohol
• Losing weight if needed
• Exercising
• Eliminating red meat, trans fats, high fructose corn syrup, and processed carbohydrates from the diet
• Medicines
• Monitoring liver functions
• Liver transplant

Additional testing is sometimes required. These tests may include ultrasound imaging or a check for blood antibody levels. If transaminase levels remain elevated for six months, the doctor may recommend a biopsy.

Transaminitis has been linked to mortality in COVID-19 patients according to research. Coronavirus disease has been well described in terms of gastrointestinal symptoms. Transaminitis has been observed in COVID-19 patients in recent studies.

Several studies have been conducted to compare the characteristics of patients with transaminitis and those who do not have transaminitis.

• Transaminitis at presentation is associated with a higher mortality rate in COVID-19 patients.
• Identifying transaminitis in COVID-19 patients is important. It will aid clinicians in prognosis based on the presence or absence of transaminitis at the time of initial presentation.
• Transaminases may act as a surrogate marker for disease severity and a predictor of mortality.
• This could be due to the virus' ability to bind to the angiotensin-converting enzyme 2 receptor. During the early stages, this binding would allow for viral entry and replication within the hepatocytes.

The clinical significance of COVID-19 infection's hepatic manifestations has prompted an attempt to describe the relationship of transaminitis with patient morbidity and mortality.