G-3410

Complementary Role of Biochemical Markers in Detecting Liver Injury Following Blunt Abdominal Trauma: A Case–Control Study

Mohammad Eslamian ¹, Bahar Kazerouni ², Pouria Abedini ² ℗, Erfan Sheikhbahaei ², Alireza Firouzfar ¹ ©, Shahrzad Hamoodi ², Behnam Sanei ¹   

 
Abstract

Introduction: Blunt abdominal trauma (BAT) is a major cause of morbidity and mortality worldwide, with the liver being among the most frequently injured organs. Early detection of liver injuries is crucial yet challenging, particularly when imaging modalities such as CT or FAST are unavailable, delayed, or inconclusive. This study aimed to evaluate the diagnostic value of routinely available biochemical markers as complementary tools for early detection of liver injury in BAT patients. Methods and Materials: We conducted a retrospective case–control study of 150 BAT patients admitted to three university-affiliated trauma centers between 2017 and 2024. Based on CT findings, patients were divided into a liver injury group (n=50) and a no liver injury group (n=100). Laboratory parameters — including AST, ALT, ALP, LDH, lipase, amylase, total and direct bilirubin, WBC, platelet count, NLR, PLR, hemoglobin, BUN, and creatinine — were collected within 24 hours of admission. Group comparisons and ROC curve analyses were performed to identify significant markers and their diagnostic performance. Results: Patients with liver injury were younger (mean 33.8 vs. 38.2 years, p=0.046), predominantly male (80% vs. 58%, p=0.010), and sustained more severe trauma, reflected by longer ICU stays and greater transfusion needs. AST, ALT, ALP, LDH, WBC, lipase, and total bilirubin were significantly higher in the liver injury group. ROC analysis demonstrated AST (cut-off 65 U/L; sensitivity 72%; specificity 97%), ALT (71.5 U/L; 76%; 92%), ALP (268 U/L; 78%; 86%), LDH (880 U/L; 64%; 93%), and lipase (28.5 U/L; 76%; 84%) as strong predictors of liver injury. Hemoglobin trends over 24 hours showed a greater decline in the liver injury group, consistent with ongoing bleeding. Conclusion and Discussion: This study highlights the potential role of biochemical markers — particularly AST, ALT, ALP, LDH, lipase, and WBC — as useful adjuncts for early identification of hepatic injuries in BAT patients, especially when imaging is delayed or unavailable. AST and ALT showed the highest diagnostic accuracy. While these markers should not replace imaging, they may enhance early clinical decision-making and improve triage. Prospective studies are recommended to validate these findings and explore their integration into trauma protocols.

Keywords: Blunt Injury; Abdominal Injury; Liver Function Tests; Biomarkers