In Reply.—In their letter, Capdevila et al1 report that 83% of 95 patients with pneumonia (of various bacterial and nonbacterial etiologies) had an elevation of one or more of the following biochemical parameters: bilirubin, aminotransferases, alkaline phosphatase, γ-glutamyl transpeptidase, and two serum bile acids (choleglycine and sulfolithocholeglycine). These results are in accord with our findings that liver biochemical abnormalties (LBA) during acute bacterial infection are (Continued on p 2209.) (Continued from p 2206.) very common.2 The investigators from Barcelona, Spain, also report that the elevation of bilirubin and choleglycine was more frequent in patients with preexisting liver disease. Although this is an interesting and original observation, the suggestion that bilirubin and choleglycine tests can help to identify patients with preexisting liver disease should be taken with caution, since 25% of the patients without preexisting liver disease also had elevated choleglycine levels. In addition, bile acid determination is
SIKULER E, GUETTA V, KEYNAN A, SCHLAEFFER F. Liver Alterations in Acute Pneumonia. Arch Intern Med. 1990;150(10):2206–2209. doi:10.1001/archinte.1990.00390210152037
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