Evaluation of Alanine Transaminase and Hepatitis B Virus DNA to Predict Liver Cirrhosis in Hepatitis B e Antigen-Negative Chronic Hepatitis B Using Transient Elastography

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Am J Gastroenterol. 2008 Dec;103(12):3071-81.

Evaluation of Alanine Transaminase and Hepatitis B Virus DNA to Predict Liver

Cirrhosis in Hepatitis B e Antigen-Negative Chronic Hepatitis B Using Transient

Elastography.

Wong GL, Wong VW, Choi PC, Chan AW, Chim AM, Yiu KK, Chan HY, Chan FK, Sung JJ,

Chan HL.

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong

SAR, China.

BACKGROUND AND AIMS: We aimed to investigate the relationship between serum

hepatitis B virus (HBV) DNA and alanine transaminase (ALT) levels and the risk

of cirrhosis in a large cohort of hepatitis B e antigen (HBeAg)-negative chronic

hepatitis B (CHB) patients based on transient elastography. METHODS: We

prospectively studied treatment-naive HBeAg-negative patients recruited based on

territory-wide referrals. We defined possible cirrhosis and probable cirrhosis

with two different cutoffs according to the results from a subgroup of patients

with histologic proof. RESULTS: One thousand one hundred ninety-seven patients

with successful liver stiffness measurement (LSM) were studied. In the subgroup

of 100 patients with liver biopsy, LSM of>/=8.4 kiloPascal (kPa) had a

sensitivity of 90% and LSM of>/=13.4 kPa had a specificity of 94% for liver

cirrhosis. Possible and probable cirrhosis were defined as a LSM value>/=8.4 kPa

and>/=13.4 kPa, and were present in 31% and 11% of the patients, respectively.

The risk of cirrhosis was significantly increased when ALT level was>0.5x upper

limit of normal (ULN) or serum HBV DNA>4 log(10) copies/mL. Among patients who

have ALT < 0.001) and 14% (125/887, P < 0.001) of those who had higher ALT and

HBV DNA levels. CONCLUSIONS: Liver cirrhosis was common among HBeAg-negative CHB

patients. Patients with ALT levels>0.5 x ULN and/or serum HBV DNA>4 log(10)

copies/mL have higher risk of cirrhosis and need further assessment for

antiviral therapy.

PMID: 19086958 [PubMed - in process]