Premium
Predictive value of ALT levels for histologic findings in chronic hepatitis C: A European collaborative study
Author(s) -
Pradat Pierre,
Alberti Alfredo,
Poynard Thierry,
Esteban JuanIgnacio,
Weiland Ola,
Marcellin Patrick,
Badalamenti Salvatore,
Trépo Christian
Publication year - 2002
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2002.35530
Subject(s) - medicine , cirrhosis , liver biopsy , gastroenterology , biopsy , predictive value , fibrosis , receiver operating characteristic , hepatology , hepatitis c virus , alanine aminotransferase , chronic hepatitis , predictive value of tests , hepatitis c , retrospective cohort study , pathology , virus , immunology
The aim of this retrospective study was to determine the predictive value of alanine aminotransferase (ALT) levels for histologic findings in patients with chronic hepatitis C virus (HCV) infection. Data on 864 HCV RNA–positive patients were collected. ALT values were obtained at the time of biopsy (before treatment), and normal ALT values were defined as normal values obtained at serial evaluations during a 6‐month period. Histologic results were scored using the METAVIR system. Among all patients, 99% of those with elevated ALT levels had a score of at least F1 (positive predictive value [PPV], 99%) and 88% had a score greater than A1F1. Among patients with persistently normal ALT values, 65% had a score of at least F1 (negative predictive value [NPV], 35%) and 26% had a score greater than A1F1. The receiver operating characteristics analysis indicates that the ALT threshold for the best compromise sensitivity‐specificity was about 2.25 times the upper limit of normal (ULN). In conclusion, almost all HCV RNA–positive patients with elevated ALT levels have some degree of fibrosis. However, an important proportion of patients with persistently normal ALT levels also show some histologic signs of fibrosis; the degree of fibrosis is usually mild but is sometimes more marked, and in rare cases cirrhosis may be present. In this subset of patients, the indication of liver biopsy and the potential benefit of therapy need to be further evaluated. These results suggest the need to revisit the algorithm for liver biopsy practice.