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
2011 Impact Factor: 4.092
2011 SCImago Journal Rankings: 0.519
DOIhttp://dx.doi.org/10.1371/journal.pone.0032622
PubMed Central IDPMC3289659
DC Field
Value
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.issn1932-6203
2011 Impact Factor: 4.092
2011 SCImago Journal Rankings: 0.519
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
Author Affiliations
  1. The University of Hong Kong