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. 2020 Apr 28;10(4):339–376. doi: 10.1016/j.jceh.2020.04.012

Table 11.

Summary of Investigations to be Done on Admission in Case Suspected to Have ALF.

Confirming the diagnosis and to rule out differential diagnosis For determining etiology For determining complications and prognosis
  • 1.

    LFTs (S bilirubin (T/D), SGOT/PT, SAP, S protein/albumin

  • 2.

    PT/INR

  • 3.

    Imaging: liver size

  • 4.

    Transjugular liver biopsy (very limited use)

  • 5.

    Other tests as per clinical suspicion of differential diagnosis such as malaria, dengue, scrub typhus, leptospira, and so on
  • 1.

    Serological screen for virus infections

  • HBsAg, anti-HBc IgM (HBV DNA), delta if positive for HBV, anti HAV IgM, anti-HEV IgM, anti-HSV IgM,

  • 2.

    In selected cases anti-VZV IgM, CMV, EBV, HIV, parvovirus, or VZV PCR (in immunocompromised patients)

  • 3.

    No tests for Wilson disease recommended

  • 4.

    Imaging of liver, color Doppler for hepatic and portal veins if Budd-Chiari syndrome suspected

  • 5.

    Echocardiogram and ECG if ischemic hepatitis suspected secondary to cardiac failure

  • 6.

    Autoimmune markers if AIH suspected:

  • ANA, ASMA, antisoluble liver antigen, globulin profile, ANCA, HLA typing

  • 7.

    Toxicology screen in urine and paracetamol serum level are not routinely available and hence not recommended
  • 1.

    CBC

  • 2.

    Procalcitonin

  • 3.

    Cultures (respiratory, blood, urine)

  • 4.

    Chest X-ray/ECG

  • 5.

    Ultrasound of liver and IVC collapsibility (CT abdomen/chest required in selected cases)

  • 6.

    KFT

  • 7.

    Electrolytes (sodium, potassium, chloride, bicarbonate, calcium, magnesium, and phosphate)

  • 8.

    Lipase or amylase

  • 9.

    Arterial ammonia

  • 10.

    Blood sugar

  • 11.

    Cardiac ECG

  • 12.

    ABG including lactate

  • 13.

    Thromboelastogram

  • 14.

    Pregnancy test in selected patients

ALF, acute liver failure; PT, prothrombin time; HBV, hepatitis B virus; HAV, hepatitis A virus; HEV, hepatitis E virus; HSV, herpes simplex virus; VZV, varicella-zoster virus; EBV, Epstein-Barr virus; HIV, human immunovirus; INR, international normalized ratio; LFT, liver function tests; PCR, polymerase chain reaction; ECG, electrocardiogram; CT, computed tomography; AIH, autoimmune hepatitis; ANA, antinuclear antibody; ASMA, antismooth muscle antibody; HLA, human leukocyte antigen; ANCA, anti-neutrophilic cytoplasmic autoantibody; ABG, arterial blood gas test; IVC, inferior vena cava; CMV, Cytomegalovirus; CBC, complete blood counts.