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Age as a predictor of significant fibrosis features in HBeAg-negative chronic hepatitis B virus infection with persistently normal alanine aminotransferase.

Tan Y, Ye Y, Zhou X, Chen L, Wen D - PLoS ONE (2015)

Bottom Line: Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN).The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Hepatosis, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.

ABSTRACT

Background: Although alanine aminotransferase (ALT) levels reflect the degree of liver damage, not all patients with chronic hepatitis B virus (HBV) infection exhibit persistently elevated ALT levels. In the present study, we aimed to comprehensively evaluate the characteristics of histological abnormalities in a large population of Chinese patients with chronic HBV and persistently normal ALT levels.

Methods: In total, 2303 consecutive patients who underwent liver biopsy were screened. Of these patients, 273 were categorized as having persistently normal ALT levels (PNALT), whereas 618 were categorized as having persistently or intermittently elevated ALT levels (PIALT). All these patients had at least three ALT values recorded in the year prior to the baseline liver biopsy.

Results: Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN). Multiple logistic regression analysis indicated that age parameters were associated with significant histological abnormalities in patients with PNALT. The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.

Conclusion: Significant histological abnormalities are not often observed in Chinese patients with PNALT. Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.

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AUC of ALT associated with significant histological characteristics in HBeAg positive and HBeAg negative patients.A: AUC of ALT associated with significant necroinflammatory scores in HBeAg positive patients; B: AUC of ALT associated with significant fibrosis scores in HBeAg positive patients; C: AUC of ALT associated with significant necroinflammatory scores in HBeAg negative patients; D: AUC of ALT associated with significant fibrosis scores in HBeAg negative patients.
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pone.0123452.g002: AUC of ALT associated with significant histological characteristics in HBeAg positive and HBeAg negative patients.A: AUC of ALT associated with significant necroinflammatory scores in HBeAg positive patients; B: AUC of ALT associated with significant fibrosis scores in HBeAg positive patients; C: AUC of ALT associated with significant necroinflammatory scores in HBeAg negative patients; D: AUC of ALT associated with significant fibrosis scores in HBeAg negative patients.

Mentions: ALT levels were used to predict the probability of being diagnosed with significant histological abnormalities in HBeAg-positive and -negative patients. The AUC of the ALT level associated with the diagnosis of significant necroinflammation in HBeAg-positive patients was 0.584 (95% confidence interval [CI], 0.523–0.645; sensitivity = 57.3%, specificity = 64.7%, P = 0.007; Fig 2A). The AUC of the ALT level associated with the diagnosis of significant necroinflammation in HBeAg-negative patients was 0.618 (95% CI, 0.554–0.681; sensitivity = 82.3%, specificity = 39.9%, P<0.001; Fig 2B). The AUC of the ALT level associated with the diagnosis of significant fibrosis in HBeAg-positive patients was 0.564 (95% CI, 0.523–0.645; sensitivity = 61.9%, specificity = 55.1%, P = 0.0526; Fig 2C). The AUC of the ALT level associated with the diagnosis of significant fibrosis in HBeAg-negative patients was 0.59 (95% CI, 0.527–0.653; sensitivity = 79.3%, specificity = 39.3%, P = 0.0049; Fig 2D).


Age as a predictor of significant fibrosis features in HBeAg-negative chronic hepatitis B virus infection with persistently normal alanine aminotransferase.

Tan Y, Ye Y, Zhou X, Chen L, Wen D - PLoS ONE (2015)

AUC of ALT associated with significant histological characteristics in HBeAg positive and HBeAg negative patients.A: AUC of ALT associated with significant necroinflammatory scores in HBeAg positive patients; B: AUC of ALT associated with significant fibrosis scores in HBeAg positive patients; C: AUC of ALT associated with significant necroinflammatory scores in HBeAg negative patients; D: AUC of ALT associated with significant fibrosis scores in HBeAg negative patients.
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pone.0123452.g002: AUC of ALT associated with significant histological characteristics in HBeAg positive and HBeAg negative patients.A: AUC of ALT associated with significant necroinflammatory scores in HBeAg positive patients; B: AUC of ALT associated with significant fibrosis scores in HBeAg positive patients; C: AUC of ALT associated with significant necroinflammatory scores in HBeAg negative patients; D: AUC of ALT associated with significant fibrosis scores in HBeAg negative patients.
Mentions: ALT levels were used to predict the probability of being diagnosed with significant histological abnormalities in HBeAg-positive and -negative patients. The AUC of the ALT level associated with the diagnosis of significant necroinflammation in HBeAg-positive patients was 0.584 (95% confidence interval [CI], 0.523–0.645; sensitivity = 57.3%, specificity = 64.7%, P = 0.007; Fig 2A). The AUC of the ALT level associated with the diagnosis of significant necroinflammation in HBeAg-negative patients was 0.618 (95% CI, 0.554–0.681; sensitivity = 82.3%, specificity = 39.9%, P<0.001; Fig 2B). The AUC of the ALT level associated with the diagnosis of significant fibrosis in HBeAg-positive patients was 0.564 (95% CI, 0.523–0.645; sensitivity = 61.9%, specificity = 55.1%, P = 0.0526; Fig 2C). The AUC of the ALT level associated with the diagnosis of significant fibrosis in HBeAg-negative patients was 0.59 (95% CI, 0.527–0.653; sensitivity = 79.3%, specificity = 39.3%, P = 0.0049; Fig 2D).

Bottom Line: Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN).The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Hepatosis, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.

ABSTRACT

Background: Although alanine aminotransferase (ALT) levels reflect the degree of liver damage, not all patients with chronic hepatitis B virus (HBV) infection exhibit persistently elevated ALT levels. In the present study, we aimed to comprehensively evaluate the characteristics of histological abnormalities in a large population of Chinese patients with chronic HBV and persistently normal ALT levels.

Methods: In total, 2303 consecutive patients who underwent liver biopsy were screened. Of these patients, 273 were categorized as having persistently normal ALT levels (PNALT), whereas 618 were categorized as having persistently or intermittently elevated ALT levels (PIALT). All these patients had at least three ALT values recorded in the year prior to the baseline liver biopsy.

Results: Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN). Multiple logistic regression analysis indicated that age parameters were associated with significant histological abnormalities in patients with PNALT. The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.

Conclusion: Significant histological abnormalities are not often observed in Chinese patients with PNALT. Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.

Show MeSH
Related in: MedlinePlus