Impact of Liver Function Tests on Clinical Outcomes in Rodenticide Poisoning: A Comprehensive Analysis of ALT, AST, and Bilirubin as Prognostic Markers

Introduction: Rodenticide poisoning, particularly from yellow phosphorus, is a growing public health issue, especially in developing countries such as India. This highly toxic substance can lead to severe liver damage, acute liver failure (ALF), and mortality. Rodenticides, often ingested in cases of self-harm, are increasingly contributing to morbidity, particularly in rural populations (Gopalakrishnan et al., 2020; Abhilash et al., 2022). Given that the liver is the primary organ affected by rodenticide poisoning, understanding the role of liver function tests in predicting clinical outcomes is critical. This study explores the prognostic value of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels in predicting the severity and mortality associated with yellow phosphorus poisoning (Sardar et al., 2019; Govindarajan et al., 2021). Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in South Gujarat, India, enrolling 70 patients diagnosed with rodenticide poisoning. A convenient sampling method was used to include adults with a history of poisoning due to yellow phosphorus. Exclusion criteria included prior liver disease or exposure to non-hepatotoxic rodenticides. Liver function tests, including ALT, AST, and total and direct/indirect bilirubin, were measured. Clinical outcomes (morbidity and mortality) were assessed in relation to these biomarkers. Statistical analysis was performed using SPSS version 26, with chi-square tests to determine significance. Results: The study found that elevated ALT, AST, and bilirubin levels were significantly associated with severe illness. Of the 70 participants, 51.4% were classified as severely ill, with 85% of these individuals exhibiting elevated ALT levels. Elevated AST and bilirubin levels were similarly observed in 83.3% of severely ill patients. Notably, ALT was the strongest predictor of mortality, with 31% of patients with elevated ALT levels dying, compared to just 2% with normal ALT levels (P = 0.001). However, no significant association was observed between mortality and AST (P = 0.345) or bilirubin levels (P = 0.08), although these markers were elevated in some cases. Discussion: The results confirm the prognostic significance of liver function tests in rodenticide poisoning. Elevated ALT levels were strongly correlated with both morbidity and mortality, supporting its role as a sensitive marker for liver damage and poor clinical outcomes. Although AST and bilirubin were also elevated in severely ill patients, they were less predictive of mortality, suggesting that ALT may be a more specific marker for liver injury in this context. These findings are consistent with previous studies, which have identified ALT as a reliable biomarker for assessing the severity of liver dysfunction in toxic exposures (Sardar et al., 2019; Gopalakrishnan et al., 2020). Elevated bilirubin, particularly both direct and indirect fractions, also showed a strong association with severe illness, reflecting the extent of hepatic dysfunction and systemic toxicity. Conclusion: This study underscores the potential of liver function tests, particularly ALT, as important prognostic markers in rodenticide poisoning. Elevated ALT levels were significantly associated with increased mortality, while elevated AST and bilirubin levels were linked to severe illness. These findings suggest that liver function tests can aid in early diagnosis, risk stratification, and management of patients with rodenticide poisoning. Clinicians should prioritize these biomarkers to better predict outcomes and guide therapeutic interventions. Future research should focus on refining these biomarkers’ utility and exploring additional indicators that may enhance prognosis and treatment in rodenticide poisoning.