 |
|
|
| |
LIVER HISTOLOGY IN HEPATITIS C PATIENTS WITH NORMAL ALT LEVELS
|
| |
| |
Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
Conclusions: A substantial proportion of hepatitis C patients with normal ALT are found to have had previous ALT elevation on
Anastasios A. Mihas, Virginia Commonwealth University and McGuire DVA Medical Center, Richmond, VA; Nisha Chand, Mitchell L. Shiffman, Virginia
Commonwealth University, Richmond, VA; H. Robert Lippman, Richmond DVA Medical Center, Richmond, VA; Souheil G. Abouassi, Adil Habib, Douglas M. Heuman, Virginia Commonwealth University, Richmond, VA
Background: Elevated serum ALT (eALT) has traditionally been a criterion in selecting patients for liver biopsy and treatment in chronic hepatitis C. However, in recent years, it has become apparent that a small number of hepatitis C patients may be cirrhotic despite normal ALT. ALT levels commonly fluctuate.
Normal ALT at a point in time may not accurately reflect the course of the hepatitis. We hypothesize that longitudinal evaluation of ALT over a period of many years, to distinguish patients with persistently normal ALT (pnALT) from those with intermittently normal ALT (inALT) may permit more accurate assessment of disease severity
Aims: The aim of this study was twofold: a) to compare the risk of cirrhosis between individuals with nALT and those with eALT at time of initial biopsy; and b) in patients with nALT, to compare the risk of cirrhosis between pnALT and inALT.
Methods: 187 consecutive patients undergoing liver biopsy for evaluation of their chronic hepatitis C were included in this study. We utilized the VA electronic records to review ALT going back as much as 20 years, extracting the highest ALT value and the current ALT at time of liver biopsy. All patients had imaging of the liver (US or CT) as well as routine hematologic, biochemical and serologic tests by standard laboratory techniques. Hepatic fibrosis was graded on a 0-6 scale according to the Ishak scoring system by two blinded reviewers. Statistical analysis was carried out with ANOVA.
Results:
The overwhelming majority of the 187 patients included in this study were male (M=173 or 92%; F=14 or 8%) reflecting the US veterans population. More than two-thirds of the patients were African Americans (68%) and less than one-third were whit (31%). The mean patient age was 53 ± 5, ranging from 41 to 71 years. At time of biopsy ALT was elevated in 76/187 (40%) and normal in 111 (60%), with 40 inALT and 71 pnALT. Serum ALT among eALT patients was 122.6 ± 48, compared to 51.5 ± 13.5 for nALT and 43.3 ± 13.3 for pnALT.. Prevalence of cirrhosis in eALT patients was 25% vs. 10% of nALT (p .05). In patients with
pnALT, cirrhosis prevalence was only 7%, whereas in nALT patients with at least one previous elevation of ALT (inALT), cirrhosis risk was 15%.
Conclusions: A substantial proportion of hepatitis C patients with normal ALT are found to have had previous ALT elevation on
|
|
| |
| |
|
|
|
|
|
