Correlation of Serum Transaminase Levels with Liver Fibrosis Assessed by Transient Elastography in Vietnamese Patients with Nonalcoholic Fatty Liver Disease

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2021 Apr 23

PMID 33889015

Citations 10

Authors

Vo Duy Thong

Bui Thi Huong Quynh

Affiliations

Soon will be listed here.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a cause of chronic liver disease, often resulting in liver cirrhosis, portal hypertension, and hepatocellular carcinoma damaging outcomes. Alanine transaminase (ALT) and aspartate aminotransferase (AST) are indicators of hepatocellular injury. Several studies have demonstrated that high ALT levels are correlated with higher nonalcoholic steatohepatitis (NASH) risk. The aim was to determine the correlation of serum alanine aminotransferase and aspartate transaminase with liver stiffness in Vietnamese patients with NAFLD.

Patients And Methods: The study included 18 to 80 years old patients diagnosed with fatty liver on ultrasound at the University of Medical Center (UMC) liver clinic. Liver stiffness was measured using transient elastography. The histopathological, demographic, and laboratory data of the participants were also collected. The baseline and clinical characteristics of NAFLD patients were stratified by serum ALT levels.

Results: There were 138 NAFLD patients, including 82 men (59.4%) and 56 women (40.6%) (mean ± SD age of 41 ± 11 years). Liver fibrosis (F0) between the two groups showed no significant difference (p = 0.469). Similarly, no difference was found in the mild fibrosis level (F2) of the two groups of patients (p = 0.371). ALT level was significantly higher in NAFLD patients with advanced fibrosis (F3, F4) (3.2% vs 15.9%, p = 0.0013; 3.2% vs 13.2%, p = 0.0047, respectively). NAFLD patients with mild to moderate fibrosis (F1-F2) were detected at 59 U/L cut-off value with 67% sensitivity and 51% specificity. However, severe fibrosis and/or cirrhosis patients (F3-F4) had a cut-off value of 81 U/L with 53% sensitivity and 67% specificity in patients.

Conclusion: Using ALT level as a marker for severe NAFLD would consider high-risk patients as mild cases, even though there is still the risk of progressive and severe hepatic disease. Our study underlines the small contribution of ALT as an independent factor for detecting NAFLD severity.

Citing Articles

Prevalence of Transaminitis and Metabolic Dysfunction-Associated Steatotic Liver Disease Among Young Indian Adults-A Population-Based Study.

Nair A, Puthiyaveettil Khadar J, Mohan Preetha A, Chellamma J, Devadas K, Kaur Gandhi T J Clin Exp Hepatol. 2025; 15(3):102466.

PMID: 39868010 PMC: 11760320. DOI: 10.1016/j.jceh.2024.102466.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Impact on Fibrosis Risk in Inactive Chronic Hepatitis B Patients: Insights from a Cross-Sectional Study.

Al-Busafi S, Al Balushi A, Al Shuaili H, Mahmood D, Al Alawi A J Clin Med. 2024; 13(16).

PMID: 39200880 PMC: 11355821. DOI: 10.3390/jcm13164738.

Barriers to care linkage and educational impact on unnecessary MASLD referrals.

Lee J, Laurel Yoon E, Oh J, Kim K, Ahn S, Won Jun D Front Med (Lausanne). 2024; 11:1407389.

PMID: 39118663 PMC: 11309125. DOI: 10.3389/fmed.2024.1407389.

Effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease: Clinical implications.

McGinty G, Przemioslo R World J Gastroenterol. 2024; 30(27):3264-3267.

PMID: 39086753 PMC: 11287414. DOI: 10.3748/wjg.v30.i27.3264.

Applications and challenges of neural networks in otolaryngology (Review).

Taciuc I, Dumitru M, Vrinceanu D, Gherghe M, Manole F, Marinescu A Biomed Rep. 2024; 20(6):92.

PMID: 38765859 PMC: 11099604. DOI: 10.3892/br.2024.1781.

References

Zeng M, Fan J, Lu L, Li Y, Chen C, Wang B . Guidelines for the diagnosis and treatment of nonalcoholic fatty liver diseases. J Dig Dis. 2008; 9(2):108-12. DOI: 10.1111/j.1751-2980.2008.00331.x. View

Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E . Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002; 137(1):1-10. DOI: 10.7326/0003-4819-137-1-200207020-00006. View

Kunde S, Lazenby A, Clements R, Abrams G . Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. Hepatology. 2005; 42(3):650-6. DOI: 10.1002/hep.20818. View

Li H, Wang Y, Tan K, Zeng L, Liu L, Liu F . Prevalence and risk factors of fatty liver disease in Chengdu, Southwest China. Hepatobiliary Pancreat Dis Int. 2009; 8(4):377-82. View

Kumar R, Rastogi A, Sharma M, Bhatia V, Tyagi P, Sharma P . Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease: diagnostic performance and clinicopathological correlation. Dig Dis Sci. 2012; 58(1):265-74. DOI: 10.1007/s10620-012-2306-1. View

Armstrong M, Houlihan D, Bentham L, Shaw J, Cramb R, Olliff S . Presence and severity of non-alcoholic fatty liver disease in a large prospective primary care cohort. J Hepatol. 2011; 56(1):234-40. DOI: 10.1016/j.jhep.2011.03.020. View

Ruhl C, Everhart J . Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2003; 124(1):71-9. DOI: 10.1053/gast.2003.50004. View

Mofrad P, Contos M, Haque M, Sargeant C, Fisher R, Luketic V . Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003; 37(6):1286-92. DOI: 10.1053/jhep.2003.50229. View

Chalasani N, Younossi Z, Lavine J, Diehl A, Brunt E, Cusi K . The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012; 55(6):2005-23. DOI: 10.1002/hep.25762. View

10.

Angulo P, Hui J, Marchesini G, Bugianesi E, George J, Farrell G . The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007; 45(4):846-54. DOI: 10.1002/hep.21496. View

11.

Amarapurka D, Amarapurkar A, Patel N, Agal S, Baigal R, Gupte P . Nonalcoholic steatohepatitis (NASH) with diabetes: predictors of liver fibrosis. Ann Hepatol. 2006; 5(1):30-3. View

12.

Wong V, Vergniol J, Wong G, Foucher J, Chan H, Le Bail B . Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010; 51(2):454-62. DOI: 10.1002/hep.23312. View

13.

Caldwell S, Oelsner D, Iezzoni J, Hespenheide E, Battle E, Driscoll C . Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999; 29(3):664-9. DOI: 10.1002/hep.510290347. View

14.

Fracanzani A, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E . Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008; 48(3):792-8. DOI: 10.1002/hep.22429. View

15.

Asrani S, Devarbhavi H, Eaton J, Kamath P . Burden of liver diseases in the world. J Hepatol. 2018; 70(1):151-171. DOI: 10.1016/j.jhep.2018.09.014. View

16.

Pratt D, KAPLAN M . Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000; 342(17):1266-71. DOI: 10.1056/NEJM200004273421707. View

17.

Machado M, Cortez-Pinto H . Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J Hepatol. 2012; 58(5):1007-19. DOI: 10.1016/j.jhep.2012.11.021. View

18.

Prashanth M, Ganesh H, Vima M, John M, Bandgar T, Joshi S . Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009; 57:205-10. View

19.

Lupsor M, Badea R, Stefanescu H, Grigorescu M, Serban A, Radu C . Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis. J Gastrointestin Liver Dis. 2010; 19(1):53-60. View

20.

Vernon G, Baranova A, Younossi Z . Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011; 34(3):274-85. DOI: 10.1111/j.1365-2036.2011.04724.x. View