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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

TitleA large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B
Authors
Issue Date2012
PublisherPublic Library of Science. The Journal's web site is located at http://www.plosone.org/home.action
Citation
PLoS One, 2012, v. 7 n. 2, article no. e32622 How to Cite?
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 >/= 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.
Persistent Identifierhttp://hdl.handle.net/10722/159633
ISSN
2013 Impact Factor: 3.534
2013 SCImago Journal Rankings: 1.724
PubMed Central ID
ISI Accession Number ID

 

Author Affiliations
  1. The University of Hong Kong
DC FieldValueLanguage
dc.contributor.authorSeto, WKen_US
dc.contributor.authorLai, CLen_US
dc.contributor.authorIp, PPCen_US
dc.contributor.authorFung, Jen_US
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.issued2012en_US
dc.identifier.citationPLoS One, 2012, v. 7 n. 2, article no. e32622en_US
dc.identifier.issn1932-6203-
dc.identifier.urihttp://hdl.handle.net/10722/159633-
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.languageengen_US
dc.publisherPublic Library of Science. The Journal's web site is located at http://www.plosone.org/home.action-
dc.relation.ispartofPLoS Oneen_US
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 Ben_US
dc.typeArticleen_US
dc.identifier.emailSeto, WK: wkseto@gmail.comen_US
dc.identifier.emailLai, CL: hrmelcl@hku.hken_US
dc.identifier.emailFung, J: jfung@sicklehut.comen_US
dc.identifier.emailWong, DKH: danwong@hku.hken_US
dc.identifier.emailHung, IFN: ivanhung@hkucc.hku.hk-
dc.identifier.emailYuen, MF: mfyuen@hkucc.hku.hk-
dc.identifier.authorityLai, CL=rp00314en_US
dc.identifier.authorityHung, IFN=rp00508en_US
dc.identifier.authorityYuen, RMF=rp00479en_US
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1371/journal.pone.0032622-
dc.identifier.pmid22389715-
dc.identifier.pmcidPMC3289659-
dc.identifier.scopuseid_2-s2.0-84857554357-
dc.identifier.hkuros203195en_US
dc.identifier.volume7-
dc.identifier.issue2, article no. e32622-
dc.identifier.isiWOS:000302999600054-
dc.publisher.placeUnited States-
dc.identifier.scopusauthoridSeto, WK=23390675900-
dc.identifier.scopusauthoridLai, CL=7403086396-
dc.identifier.scopusauthoridIp, PPC=54958906200-
dc.identifier.scopusauthoridFung, J=55032286400-
dc.identifier.scopusauthoridWong, DKH=7401535819-
dc.identifier.scopusauthoridYuen, JCH=7102620480-
dc.identifier.scopusauthoridHung, IFN=7006103457-
dc.identifier.scopusauthoridYuen, MF=7102031955-

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