eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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abstract:
Original paper

Evaluation of glutamate dehydrogenase (GLDH) as a diagnostic and prognostic marker in drug-induced liver injury

Omkolsoum Alhaddad
1
,
Maha Elsabaawy
1
,
Amany Salah
1
,
Olfat Hendy
2
,
Dalia Elsabaawy
3
,
Mohamed Mazaly
1
,
Aliaa Sabry
1

  1. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El Kom, Egypt
  2. Clinical Pathology Department, National Liver Institute, Menoufia University, Shebin El Kom, Egypt
  3. Clinical Pharmacy Department, Faculty of Pharmacy, Menoufia University, Shebin El Kom, Egypt
Gastroenterology Rev 2025; 20 (1)
DOI: https://doi.org/10.5114/pg.2024.143153
Online publish date: 2024/09/23
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Introduction
Drug-induced liver injury (DILI) is a significant clinical event, associated with notable morbidity and mortality. The paucity of DILI diagnostic and/or prognostic biomarkers still represents an unmet need.

Aim
We aimed to evaluate the role of glutamate dehydrogenase (GLDH) as a diagnostic and prognostic marker in patients with DILI.

Material and methods
A case-control study was conducted on 40 acute DILI patients and 40 acute viral hepatitis patients, in addition to a healthy control group (20). Clinical and laboratory characteristics were evaluated including ELISA assay of GLDH, along with RUCAM score and liver biopsy whenever feasible. All cases were followed up for 6 months. Diclofenac was the most incriminated drug in DILI (40%). GLDH was higher in the DILI than control and acute viral hepatitis patients (18.5 ±10.4, 0.89 ±0.6, 1.5 ±1.2 U/l) respectively (p < 0.001). Moreover, it was strongly correlated with aminotransferases, alkaline phosphatase, prothrombin concentration (PC), and bilirubin. The GLDH level in hepatocellular injury was 24.5 ±4.4 U/l, while it was 1.5.5 ±0.6 U/l in mixed and 3.5 ±1.1 U/l in cholestatic injury (p < 0.001). The AUC for GLDH level was 0.936 (p < 0.001) at a cutoff of 2.1 U/l, where the sensitivity was 90%, specificity 85%, positive predictive value 91.08% and negative predictive value 83.31% in prediction of DILI. GLDH was higher in patients who died than those who survived (32.36 ±1.1 vs. 15.36 ±10.1 U/l, respectively) (p = 0.000). Multivariate analysis defined age, bilirubin, and GLDH as independent predictors of poor outcomes in DILI.

Conclusions
GLDH is a highly specific, simple, real-time, and inexpensive diagnostic and prognostic marker of DILI and shows potential to address this unmet need.

keywords:

DILI, GLDH, diagnostic, prognostic, marker
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