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Updated thresholds for alanine aminotransferase do not exclude significant histological disease in chronic hepatitis C
Author(s) -
Sanai Faisal M.,
Helmy Ahmed,
Dale Cheryl,
AlAshgar Hamad,
Abdo Ayman A.,
Katada Kazuhiro,
AlMana Hadeel,
Saadeh Mayssa,
AlHussaini Hussa,
AlQuaiz Mohammed,
Hashem Ahmed,
AlSwat Khalid,
Bzeizi Khalid I.,
Marotta Paul J.
Publication year - 2011
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2011.02551.x
Subject(s) - medicine , gastroenterology , alanine aminotransferase , odds ratio , alanine transaminase , confidence interval , steatosis , fibrosis , fatty liver , disease
Background and aim: Histological changes in hepatitis C virus (HCV)‐infected patients with persistently normal alanine aminotransferase (PNALT) have not been evaluated for updated upper limits of normal (ULN; ≤19/30U/L for females/males). We assessed significant fibrosis (≥F2, METAVIR) in patients with PNALT and persistently elevated alanine aminotransferase (PEALT). Patients and methods: Nine hundred and twenty consecutive, unselected HCV patients were stratified into four groups: Group I: ( n =124) PNALT within the updated ULN [0.5 × ULN (corresponding to ≤19 U/L) for females; 0.75 × ULN (corresponding to ≤30 U/L) for males]; Group II ( n =173): PNALT≤1 × ULN but greater than Group I; Group III ( n =313): PEALT 1–2 × ULN; and Group IV ( n =310): PEALT>2 × ULN. PNALT was defined as ≥3 determinations within the normal range over ≥6 months. Results: Advanced ≥F3 and ≥F2 fibrosis increased incrementally across Groups I; II; III; and IV: 24.2 and 45.2%; 25.4 and 56.1%; 36.1 and 64.2%; and 50 and 77.1% respectively ( P <0.0001 for both). Multivariable logistic regression analysis identified age [odds ratio (OR), 1.05; 95% confidence intervals (CI): 1.02–1.08; P <0.0001], alanine aminotransferase (ALT) groups (OR 1.38; 95% CI: 1.03–1.83; P =0.030), presence of moderate–severe steatosis (OR 2.70; 95% CI: 1.19–6.15; P =0.018) and ≥A2 necroinflammation (OR 17.9; 95% CI: 8.88–36.20; P <0.0001) as independent predictors of ≥F2 fibrosis. Updated ULN for ALT were better at excluding ≥F2 fibrosis compared with traditional ULN (90.6 vs. 74.2%, P =0.0041) but less specific (20.8 vs. 44%, P =0.0007) with similar positive/negative predictive values. Conclusions: HCV patients with ‘updated’ normal ALT have the lowest prevalence of significant fibrosis, although utilizing these levels without resorting to biopsy would miss significant fibrosis in almost one‐half of such patients.