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Article: A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B
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TitleA large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B
 
AuthorsSeto, WK1
Lai, CL1
Ip, PPC1
Fung, J1
Wong, DKH1
Yuen, JCH1
Hung, IFN1
Yuen, MF1
 
Issue Date2012
 
PublisherPublic Library of Science. The Journal's web site is located at http://www.plosone.org/home.action
 
CitationPLoS One, 2012, v. 7 n. 2, article no. e32622 [How to Cite?]
DOI: http://dx.doi.org/10.1371/journal.pone.0032622
 
AbstractOBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading >/= 7 or fibrosis score >/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and > x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.
 
ISSN1932-6203
2013 Impact Factor: 3.534
2013 SCImago Journal Rankings: 1.724
 
DOIhttp://dx.doi.org/10.1371/journal.pone.0032622
 
PubMed Central IDPMC3289659
 
ISI Accession Number IDWOS:000302999600054
 
DC FieldValue
dc.contributor.authorSeto, WK
 
dc.contributor.authorLai, CL
 
dc.contributor.authorIp, PPC
 
dc.contributor.authorFung, J
 
dc.contributor.authorWong, DKH
 
dc.contributor.authorYuen, JCH
 
dc.contributor.authorHung, IFN
 
dc.contributor.authorYuen, MF
 
dc.date.accessioned2012-08-16T05:53:34Z
 
dc.date.available2012-08-16T05:53:34Z
 
dc.date.issued2012
 
dc.description.abstractOBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading >/= 7 or fibrosis score >/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and > x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.
 
dc.description.naturepublished_or_final_version
 
dc.identifier.citationPLoS One, 2012, v. 7 n. 2, article no. e32622 [How to Cite?]
DOI: http://dx.doi.org/10.1371/journal.pone.0032622
 
dc.identifier.doihttp://dx.doi.org/10.1371/journal.pone.0032622
 
dc.identifier.hkuros203195
 
dc.identifier.isiWOS:000302999600054
 
dc.identifier.issn1932-6203
2013 Impact Factor: 3.534
2013 SCImago Journal Rankings: 1.724
 
dc.identifier.issue2, article no. e32622
 
dc.identifier.pmcidPMC3289659
 
dc.identifier.pmid22389715
 
dc.identifier.scopuseid_2-s2.0-84857554357
 
dc.identifier.urihttp://hdl.handle.net/10722/159633
 
dc.identifier.volume7
 
dc.languageeng
 
dc.publisherPublic Library of Science. The Journal's web site is located at http://www.plosone.org/home.action
 
dc.publisher.placeUnited States
 
dc.relation.ispartofPLoS One
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshAdolescent
 
dc.subject.meshAlanine Transaminase - metabolism
 
dc.subject.meshHepatitis B e Antigens - metabolism
 
dc.subject.meshHepatitis B, Chronic - enzymology - pathology
 
dc.subject.meshLiver Cirrhosis - enzymology - pathology
 
dc.titleA large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B
 
dc.typeArticle
 
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<item><contributor.author>Seto, WK</contributor.author>
<contributor.author>Lai, CL</contributor.author>
<contributor.author>Ip, PPC</contributor.author>
<contributor.author>Fung, J</contributor.author>
<contributor.author>Wong, DKH</contributor.author>
<contributor.author>Yuen, JCH</contributor.author>
<contributor.author>Hung, IFN</contributor.author>
<contributor.author>Yuen, MF</contributor.author>
<date.accessioned>2012-08-16T05:53:34Z</date.accessioned>
<date.available>2012-08-16T05:53:34Z</date.available>
<date.issued>2012</date.issued>
<identifier.citation>PLoS One, 2012, v. 7 n. 2, article no. e32622</identifier.citation>
<identifier.issn>1932-6203</identifier.issn>
<identifier.uri>http://hdl.handle.net/10722/159633</identifier.uri>
<description.abstract>OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading &gt;/= 7 or fibrosis score &gt;/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and &gt; x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.</description.abstract>
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<subject.mesh>Adolescent</subject.mesh>
<subject.mesh>Alanine Transaminase - metabolism</subject.mesh>
<subject.mesh>Hepatitis B e Antigens - metabolism</subject.mesh>
<subject.mesh>Hepatitis B, Chronic - enzymology - pathology</subject.mesh>
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Author Affiliations
  1. The University of Hong Kong