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Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B.


ABSTRACT: AIM:To explore the effect of alanine aminotransferase (ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B (CHB) patients. METHODS:A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: Normal ALT (ALT ? 40), slightly elevated ALT (40 < ALT ? 80) and elevated ALT (ALT > 80). The diagnostic performance of five common non-invasive fibrosis tests for liver fibrosis (stages S2-4), including the aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), fibrosis index based on 4 factors (FIB-4), King's score, Forns index and gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR), were evaluated for each group. RESULTS:Higher ALT levels were associated with higher non-invasive fibrosis test scores. Patients with the same fibrosis stage but higher ALT levels showed higher non-invasive test scores. The areas under the receiver operating characteristics curves (AUROCs) of the non-invasive tests for prediction of ? S2 were higher for patients with ALT ? 40 U/L (range 0.705-0.755) and 40 < ALT ? 80 U/L (range 0.726-0.79) than for patients with ALT > 80 U/L (range 0.604-0.701). The AUROCs for predicting ? S3 and S4 were higher in patients with ALT ? 40 U/L (range 0.736-0.814 for ? S3, 0.79-0.833 for S4) than in patients with 40 < ALT ? 80 U/L (range 0.732-0.754 for ? S3, range 0.626-0.723 for S4) and ALT > 80 U/L (range 0.7-0.784 for ? S3, range 0.662-0.719 for S4). The diagnostic accuracy of the non-invasive tests decreased in a stepwise manner with the increase in ALT. CONCLUSION:ALT has a significant effect on the diagnostic performance of non-invasive fibrosis tests. The ALT level should be considered before performing these non-invasive tests.

SUBMITTER: Wang L 

PROVIDER: S-EPMC6212603 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B.

Wang Lin L   Fan Yao-Xin YX   Dou Xiao-Guang XG  

World journal of clinical cases 20181001 12


<h4>Aim</h4>To explore the effect of alanine aminotransferase (ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B (CHB) patients.<h4>Methods</h4>A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: Normal ALT (ALT ≤ 40), slightly elevated ALT (40 < ALT ≤ 80) and elevated ALT (ALT > 80). The diagnostic performance of five common non-invasive fibrosis tests for liver fibrosis (st  ...[more]

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