Why Do Liver Enzyme Levels Vary Between Different Hospitals?

Liver function tests show two values in one day?

I would like to ask about my uncle, who had liver issues and went to the hospital for tests.
Initially, he had tests done at Hualien Tzu Chi Hospital, but later, feeling uneasy, he returned to Taipei and had another set of tests at National Taiwan University Hospital on the same day, in the morning and afternoon.
However, the test results showed a score in the eighties from Hualien, while the results from Taipei were only in the fifties.
What could be the reason for this discrepancy? Is it possible for the values to fluctuate so rapidly, or could there be an issue with the report results? Thank you.

weny, 20~29 year old female. Ask Date: 2005/07/21

Dr. Xiao Jingqin reply Internal Medicine

The standard values for liver function tests (AST or ALT) vary between laboratories.
Generally, the normal upper limit for these tests is around 40 IU/L, but this can differ from one lab to another; for instance, our hospital's upper limit is 37 IU/L.
When considering the significance of abnormal liver function indices, values that are more than twice the normal upper limit (approximately >80 IU/L) are generally more meaningful, especially if they persist for at least three months or even six months or longer.
At this point, it is crucial to investigate the underlying causes of the liver function abnormalities, which may include viral hepatitis, drug-induced liver injury, or fatty liver disease.
Additionally, it is common for repeated tests to yield slightly different values, similar to how blood glucose levels can also vary.

Reply Date: 2005/07/21

More Info

The variation in liver enzyme levels between different hospitals can be attributed to several factors, including differences in laboratory techniques, equipment calibration, sample handling, and even biological variability in patients.
Firstly, each hospital may use different laboratory methods or equipment to measure liver enzymes such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase). These enzymes are typically measured in international units per liter (IU/L), and the assays used can have different sensitivities and specificities. For example, one laboratory might use a method that is more sensitive to detecting enzyme levels, while another might have a less sensitive method, leading to discrepancies in results.

Secondly, the calibration of the equipment used in the laboratories can also affect the results. If one lab's equipment is not calibrated correctly, it may report higher or lower enzyme levels than what is actually present in the blood sample. Regular calibration and maintenance of laboratory equipment are crucial for ensuring accurate results.

Sample handling is another critical factor. The time taken to process the blood sample, the conditions under which it is stored, and the time elapsed before analysis can all influence enzyme levels. For instance, if a sample is not processed quickly enough or is exposed to inappropriate temperatures, it may lead to degradation of the enzymes, resulting in falsely low readings.

Biological variability is also an important consideration. Liver enzyme levels can fluctuate due to various factors, including diet, physical activity, stress, and even the time of day when the blood is drawn. For example, if your uncle had a meal high in fat before the test, it could temporarily elevate liver enzyme levels. Additionally, if he was under stress or had not slept well, this could also impact the results.

Moreover, the timing of the tests can play a role. If your uncle had the tests done at different times of the day, this could contribute to variations in the results. Enzyme levels can fluctuate throughout the day, and it is generally recommended to have blood drawn at the same time of day for consistency.

Lastly, it is essential to consider the possibility of laboratory errors. While rare, mistakes can occur in any laboratory setting, from mislabeling samples to clerical errors in reporting results. If there is a significant discrepancy between the results from two different hospitals, it may be worth discussing with a healthcare provider to determine whether a repeat test is necessary for confirmation.

In conclusion, the variation in liver enzyme levels between different hospitals can arise from a combination of laboratory methods, equipment calibration, sample handling, biological variability, and potential laboratory errors. If there are concerns about the accuracy of the results, it is advisable to consult with a healthcare professional who can provide guidance on the next steps, which may include retesting or further evaluation of liver function.

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