Serum markers for necroinflammatory activity in patients with chronic viral hepatitis and normal or mildly elevated aminotransferase levels

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http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02570.x/abstract

Serum markers for necroinflammatory activity in patients with chronic viral

hepatitis and normal or mildly elevated aminotransferase levels

Jae Y. Cheong1, Dong J. Kim2, Seong G. Hwang3, Jin M. Yang4, Young B. Kim5,

Young N. Park6, Sung W. Cho1

Article first published online: 23 JUN 2011

DOI: 10.1111/j.1478-3231.2011.02570.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Early View (Online Version of Record published before inclusion in an issue)

Abstract

Background: Reports on the usefulness of serum markers for predicting liver

necroinflammation are limited. The aim of this study was to determine the serum

markers that predict significant inflammation in patients with chronic hepatitis

B (CHB) and C (CHC) and normal or mildly elevated serum aminotransferase levels.

Methods: Two hundred twenty-seven patients with CHB or CHC with normal or mildly

elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase

(AST) levels (≤60 IU/L) were enrolled in this study. Significant inflammation

was defined as inflammatory grade ≥3 activities using the Batt–Ludwig

scoring system. The correlation between liver histology and serum markers of

liver inflammation was analysed.

Results: Forty-eight (21.1%) and eight patients (3.5%) had grade 3 and 4

inflammation respectively. Univariate analysis revealed that age, platelet coun,

and AST, ALT, γ-glutamyl transpeptidase, alkaline phosphatase, hyaluronic acid,

haptoglobin, apolipoprotein A1 and procollagen III N-terminal peptide levels

were significantly different between the patients with and without significant

inflammation. There were no significant differences in the cytokeratin-18

fragment levels between the two groups. On the basis of multivariate analysis,

the AST and apolipoprotein A1 levels and stage of fibrosis were highly

predictive of significant inflammation. Using AST and apolipoprotein cut-off

values ≥44 IU/L and ≤100 ng/ml, respectively, the presence of significant

inflammation was predicted with high specificity (96.5%) and with a negative

predictive value of 76.3%.

Conclusion: The AST and apolipoprotein A1 levels were shown to be independent

predictors of significant inflammatory activities in patients with CHB and CHC

and normal or mildly elevated aminotransferase levels.