Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 521-530
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.521
Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B
Lin Wang, Yao-Xin Fan, Xiao-Guang Dou
Lin Wang, Yao-Xin Fan, Xiao-Guang Dou, Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
Author contributions: Wang L and Fan YX designed the study, enrolled the patients, analyzed the data and prepared the manuscript; Dou XG designed and supervised the study.
Supported by the Liaoning Provincial Science and Technology Key Project for Translational Medicine, No. 2014225020; Outstanding Scientific Fund of Shengjing Hospital, No. 201102; Liaoning Provincial Science and Technology Key Project for Translational Medicine, No. 2016509; and National Science and Technology Major Project, Nos. 2017ZX10201201, 2017ZX10202202, 2017ZX10202203.
Institutional review board statement: The study was approved by the Medical Ethics Committee of Shengjing Hospital of China Medical University.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data obtained after each patient provided written consent for treatment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Guang Dou, MD, Professor, Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Shenyang 110022, Liaoning Province, China. guang40@163.com
Telephone: +86-24-9661562211
Received: July 19, 2018
Peer-review started: July 19, 2018
First decision: August 8, 2018
Revised: August 17, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 26, 2018
ARTICLE HIGHLIGHTS
Research background

Because of their high applicability and good interlaboratory reproducibility, many convenient non-invasive fibrosis tests have been established. Many studies have reported the influence of alanine aminotransferase (ALT) levels on liver stiffness (LS) measurements. However, no report has investigated the effects of changes in the serum ALT levels of chronic hepatitis B (CHB) patients on the diagnostic performances of these non-invasive tests.

Research objectives

To explore the effect of serum ALT on the diagnostic performances of non-invasive fibrosis tests in CHB patients.

Research methods

A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: normal ALT (ALT ≤ 40), slightly elevated ALT (40 < ALT ≤ 80) and elevated ALT (ALT > 80). The diagnostic performances of five common non-invasive fibrosis tests for liver fibrosis (stages S2-4), including the aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), fibrosis index based on 4 factors (FIB-4), King’s score, Forns index and gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR), were evaluated for each group.

Research results

Higher ALT levels were associated with higher non-invasive test scores for the prediction of liver fibrosis. Patients with the same fibrosis stage but higher ALT levels showed higher non-invasive test scores. The areas under the receiver operating characteristics curves (AUROCs) of the non-invasive tests for the ≥ S2 prediction were higher in patients with ALT ≤ 40 U/L (range 0.705-0.755) and 40 < ALT ≤ 80 U/L (range 0.726-0.79) than in patients with ALT > 80 U/L (range 0.604-0.701). The AUROCs for the ≥ S3 and S4 predictions were higher in patients with ALT ≤ 40 U/L (range 0.736-0.814 for ≥ S3, 0.79-0.833 for S4) than in patients with 40 < ALT ≤ 80 U/L (range 0.732-0.754 for ≥ S3, range 0.626-0.723 for S4) and ALT > 80 U/L (range 0.7-0.784 for ≥ S3, range 0.662-0.719 for S4). The diagnostic accuracy of the non-invasive fibrosis tests decreased in a stepwise manner with the increase ALT level.

Research conclusions

ALT has a significant effect on the diagnostic performances of non-invasive fibrosis tests.

Research perspectives

The ALT level should be considered before performing these non-invasive tests.