LIVER FUNCTION TESTS IN PATIENTS WITH ALCOHOL USE DISORDER: FINDINGS FROM A TERTIARY CARE PSYCHIATRY UNIT IN MUMBAI

Alcohol-related liver disease (ARLD) spans a pathological spectrum from hepatic steatosis to fibrosis and cirrhosis. Liver function tests (LFTs) including aminotransferases, bilirubin, and albumin   constitute the standard first-line biochemical evaluation in patients with suspected hepatic injury. However, a clinically important challenge is that routine LFT values can remain within normal limits even in the presence of significant underlying liver pathology. This phenomenon has particular relevance in patients with alcohol use disorder (AUD), among whom hepatic damage may be advanced at the time of clinical presentation. This was a retrospective chart analysis conducted at a tertiary care centre in Mumbai. Indoor case records of all patients admitted to the psychiatry ward between January 2020 and December 2021 with a diagnosis of alcohol use disorder and a minimum of 12 months of regular alcohol consumption were reviewed. Demographic characteristics, type and pattern of alcohol consumption, comorbid substance use, LFT parameters (total bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, and clinical signs of hepatic dysfunction were systematically extracted. One hundred male patients with AUD were included (mean age 38.35 ± 11.1 years; range 18–61 years). Although 55% and 36% of patients had AST and ALT values exceeding the upper limit of the reference range, respectively, clinically significant elevations were present in only 7% (AST) and 5% (ALT) of cases. An AST:ALT ratio > 2, suggestive of alcoholic liver injury, was identified in only 19 patients (19%). Only 6 patients exhibited clinical signs of hepatic decompensation. The majority of patients thus had normal or only mildly elevated LFT values despite chronic alcohol use. A substantial proportion of patients with alcohol use disorder may exhibit normal or minimally deranged liver enzyme levels despite prolonged alcohol exposure. These findings underscore the inadequacy of LFTs as sole screening tools for alcohol-related liver disease and support the use of complementary non-invasive modalities   including transient elastography (FibroScan), FIB-4 index, and APRI score   in the clinical evaluation of this population.