Indian Journal of Medical Biochemistry

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VOLUME 22 , ISSUE 2 ( July-December, 2018 ) > List of Articles


A Comparative Study in Assessing the Usefulness of Serum Cholinesterase, High Sensitivity C-reactive Protein with Liver Function Tests in Alcoholic Liver Disease

Hemantha Kumara DS, Muralidhara Krishna CS, HL Vishwanath

Keywords : Alcoholic cirrhosis, Hs-CRP, Non-alcoholic cirrhosis, Serum Cholinesterase.

Citation Information : DS HK, CS MK, Vishwanath H. A Comparative Study in Assessing the Usefulness of Serum Cholinesterase, High Sensitivity C-reactive Protein with Liver Function Tests in Alcoholic Liver Disease. Indian J Med Biochem 2018; 22 (2):147-153.

DOI: 10.5005/jp-journals-10054-0073

License: CC BY-NC 3.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Chronic alcohol ingestion is one of the major causes of liver disease. The pathology of alcoholic liver disease consists of three major lesions (1) fatty liver; (2) alcoholic hepatitis; and (3) cirrhosis. Fatty liver is present in >90% of binge and chronic drinkers with a smaller percentage of heavy drinkers progressing to alcoholic hepatitis thought to be a precursor to cirrhosis. A lot of studies have been conducted in the past but requires further studies to prove its usefulness in the diagnosis of liver diseases. The present study has been planned to find out the use of assay of serum cholinesterase and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of alcoholic liver disease. Materials and methods: Thirty male cases diagnosed with the alcoholic liver disease were compared with 30 male normal subjects as controls and 30 male non-alcoholic liver disease patients as an additional study group. The diagnosis was based on interview and questionnaire, clinical signs of liver disease and supporting laboratory tests [bilirubin, total protein, serum albumin, albumin:globulin (A:G), aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT)] and ultrasound. Results and discussion: The study showed deranged liver function tests in both alcoholic and non-alcoholic cirrhosis patients compared to controls and normal liver function tests in controls. The serum cholinesterase levels were significantly decreased in alcoholic cirrhosis patients (2112.43 ± 1195.94) compared to non-alcoholic cirrhosis (4004.73 ± 971.03) patients with p-value < 0.001 whereas hs-CRP levels were significantly increased in non-alcoholic cirrhosis patients (1.79 ± 0.28) compared to alcoholic cirrhosis patients (1.23 ± 0.42) with p-value < 0.001. Conclusion: To conclude, the marked decrease in serum cholinesterase in alcoholic cirrhosis patients suggest that its activity might be a specific indicator of liver dysfunction and may be used for the diagnosis of alcoholic cirrhosis patients and the hs-CRP can be used as a strong predictor of non-alcoholic cirrhosis.

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  1. O'Shea RS, Dasarathy S, McCullough AJ; Practice Guideline Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010 Jan;51(1):307-328.
  2. Macdonald G. Harrison's Internal Medicine, 17th edition. - by Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL and Loscalzo J. Internal Medicine Journal [Internet]. Wiley; 2008 Dec;38(12):932–932.
  3. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J. 2004 Nov;24(5):861-880.
  4. Flier JS, Underhill LH, Friedman SL. The Cellular Basis of Hepatic Fibrosis -- Mechanisms and Treatment Strategies. New England Journal of Medicine [Internet]. New England Journal of Medicine (NEJM/MMS); 1993 Jun 24;328(25):1828-1835. 5 Pinzani M. Hepatic stellate (ITO) cells: expanding roles for a liver-specific pericyte. Journal of Hepatology [Internet]. Elsevier BV; 1995 Jun;22(6):700-706.
  5. Khanna S, editor. Non-Alcoholic Fatty Liver Disease-ECAB. Elsevier Health Sciences; 2013 Apr 15;10-12.
  6. Gururaj G, Murthy P, Rao GN, Benegal V. Alcohol Related Harm: Implications for public health and policy in India. National Institute of Mental Health & Neuro Sciences, Bengaluru. 20;54.
  7. Das SK, Balakrishnan V, Vasudevan DM. Alcohol: its health and social impact in India. National Medical Journal of India. 2006 Mar 1;19(2):94.
  8. Meng F, Yin X, Ma X, Guo XD, Jin B, Li H. Assessment of the value of serum cholinesterase as a liver function test for cirrhotic patients. Biomedical reports. 2013 Mar-Apr 1;1(2): 265-268.
  9. Wilson A, Calvert RJ, Geoghegan H. Plasma cholinesterase activity in liver disease: its value as a diagnostic test of liver function compared with flocculation tests and plasma protein determinations. The Journal of clinical investigation. 1952 Sep 1;31(9):815-823.
  10. Rao SV, Kiran VR, Indira S. A Comparative Study of Pseudocholinesterase and Liver Function Test in Cirrhosis of Liver, Infective Hepatitis and Obstructive Jaundice: A Case Control Study. JCDR. 2011;5(4):729-732.
  11. Galanti B, Russo M, Nardiello S, Guarino F. Serum cholinesterase activity (CHE) in different classes of chronic liver diseases (author's transl). Quaderni Sclavo di diagnostica clinica e di laboratorio. 1978 Mar;14(1):95-102.
  12. Ramachandran J, Sajith KG, Priya S, Dutta AK, Balasubramanian KA. Serum cholinesterase is an excellent biomarker of liver cirrhosis. Trop Gastroenterol. 2014 Jan-Mar;35(1):15-20.
  13. Ogunkeye OO, Roluga AI. Serum cholinesterase activity helps to distinguish between liver disease and non-liver disease aberration in liver function tests. Pathophysiology. 2006 May;13(2):91-93. Epub 2006 Mar 10.
  14. Ndumele CE, Nasir K, Conceiçao RD, Carvalho JA, Blumenthal RS, Santos RD. Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation. Arteriosclerosis, thrombosis, and vascular biology. 2011 Aug 1;31(8):1927- 1932.
  15. Yeniova AO, Küçükazman M, Ata N, Dal K, Kefeli A, Ba yi it S, et al. High-sensitivity C-reactive protein is a strong predictor of non-alcoholic fatty liver disease. Hepato-gastroenterology. 2014;61(130):422-425.
  16. Kogiso T, Morivoshi Y, Nagahara H. 691 Clinical significance of high sensitivity C-reactive protein (hs-CRP) in nonalcoholic fatty liver disease (NAFLD). Journal of Hepatology. 2006 Apr 1;44 (Suppl 2):S255.
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