Biochemical Criteria for Perioperative Biliary Dysfunction

Criteria for biliary dysfunction with normal preoperative liver function tests - one or more of the following:

(1) total bilirubin > 3.0 mg/dL

(2) alkaline phosphatase > 375 U/L

(3) AST > 45 U/L

Criteria for biliary dysfunction with abnormal preoperative liver function tests - one or more of the following:

(1) total bilirubin > 1.5 * (preoperative value)

(2) alkaline phosphatase > 1.5 * (preoperative value)

(3) AST > 45 U/L  > 1.5 * (preoperative value)

where:

• The normal ranges for total bilirubin, AST and alkaline phosphatase are not given. Since the authors are from the Mayo Clinic I assume that I can use the normal ranges from there.

• If the AST = 45 U/L is 1.5 times the upper limit of the normal reference range, then the upper limit would be 30 U/L.

• If the alkaline phosphatase = 375 U/L is 1.5 times the upper limit of the normal reference range, then the upper limit would be 250 U/L.

• The upper limit for the normal reference range of total bilirubin is 2.0 mg/dL.

Limitations:

• Hemolysis can cause a rise in bilirubin and AST.