Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 2104-2112
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2104
Liver function tests and metabolic-associated fatty liver disease: Changes in upper normal limits, does it really matter?
Roberta Forlano, Benjamin H Mullish, Ameet Dhar, Robert D Goldin, Mark Thursz, Pinelopi Manousou
Roberta Forlano, Benjamin H Mullish, Ameet Dhar, Mark Thursz, Pinelopi Manousou, Liver Unit/Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W2 1NY, United Kingdom
Robert D Goldin, Centre for Pathology, Department of Medicine, Imperial College London, London W2 1NY, United Kingdom
Author contributions: Forlano R performed the research and wrote the paper; Mullish BH, Dhar A, Goldin RD, Thursz MR provided clinical advice and contributed to the draft; Manousou P designed the research and supervised the report.
Supported by National Institute of Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London; NIHR Academic Clinical Lectureship, No. CL-2019-21-002; European Association for The Study of the Liver, PhD fellowship Juan Rodes 2018.
Institutional review board statement: This study was considered a service evaluation project, using routinely collected patient data, therefore no ethical approval was required under the UK policy framework for health and social care.
Informed consent statement: The Informed consent is not required.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Pinelopi Manousou, MD, PhD, Senior Lecturer, Liver Unit/Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Exhibition Road, London W2 1NY, United Kingdom.
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 23, 2021
Revised: July 2, 2021
Accepted: November 15, 2021
Article in press: November 15, 2021
Published online: December 27, 2021
Research background

Elevated liver function tests (LFTs) often represent the main reason for referring patients with metabolic-associated fatty liver disease (MAFLD) to secondary and tertiary care.

Research motivation

In MAFLD, liver function tests may both under and over-estimate liver disease. Moreover, difference in upper normal limit (UNL) of LFTs is consistent across the literature.

Research objectives

As such, we investigated the potential use of different UNLs of LFTs in MAFLD.

Research methods

We evaluated the use of a lower UNL of ALT vs histology and liver stiffness measurement in a cohort of 436 patients with non-alcoholic fatty liver disease in a tertiary care centre.

Research results

Modifying the upper normal limit of LFTs does not improve the diagnostic performance of the test in MAFLD.

Research conclusions

In MAFLD, the risk-stratification should rely on a combination of risk factors and non-invasive markers, rather than on LFTs alone.

Research perspectives

Future research should focus on identifying biomarkers for diagnosing metabolic-associated steato-hepatitis and advanced fibrosis.