Liver function tests in chronic viral hepatitis cases

Abstract

The liver has many vital functions and biochemical tests are usedfor the assessment. For the diagnosis of chronic hepatitis: (1)persistence of increased alanine aminotransferase (ALT) for 6months after an episode of acute hepatitis; or (2) increased ALT(without another explanation) on more than one occasion over aperiod of 6 months are needed. The time period may be shorter forthe patients with risk factors. Although the clinical picture of HBVand HCV in chronic cases is similar, aminotransferase activitiesare different. In HBV, ALT activity is generally constant, exceptincreases are evident at seroconversion times. On the other hand,two-third of HCV cases experience fluctuation. In the evaluationof a patient with a new diagnosis of chronic viral hepatitis, acomprehensive medical history should be taken, followed byfull physical examination. Laboratory workup should start with acomprehensive metabolic panel with liver function tests includingassessment of synthetic function with prothrombin time and serumalbumin level measurement. Screening for the chronic hepaticinjury is not cost-effective and should be limited to high-riskindividuals. ALT should be the preferred biochemistry parameterbesides viral serology and increased activity should be confirmedbefore further evaluation. For treatment, patients with increasedALT are more likely to respond than those with initially normalALT activity.Keywords: Chronic viral hepatitis, Hepatitis B virus, Hepatitis Cvirus, Alanine aminotransferase, Aspartate aminotransferase

References

1. Burtis CA, Ashwood ER, Bruns D (editors). Tietz Textbook
2. of Clinical Chemistry and Molecular Medicine. St. Louis
3. Elsevier Saunders, 2006: 1777-847.
4. Dufour D, Lott J, Nolte F, et al. Diagnosis and monitoring
5. of hepatic injury. II. Recommendations for use of laboratory
6. tests in screening, diagnosis, and monitoring. Clin Chem
7. 46:2050-68.
8. Dincer D, Okten A, Kaymakoglu S, et al. Persistantly normal

9. alanine transaminase levels in chronic C hepatitis: What does
10. it tell us? Hepatogastroenterology 2001;48:1397-400.
11. Mofrad P, Contos M, Haque M, et al. Clinical and histologic
12. spectrum of nonalcoholic fatty liver disease associated with
13. normal ALT values. Hepatology 2003;37:1286-92.
14. Dufour DR. Alanine aminotransferase variation in chronic
15. hepatitis C infection: An analysis of 357 cases. Clin Chem
16. 47:A26-A7.
17. Alter HJ, Conry-Cantilena C, Melpolder J, et al. Hepatitis C
18. in asymptomatic blood donors. Hepatology 1997;26(Suppl
19. 29–33.
20. Mathurin P, Moussalli J, Cadranel J-F, et al. Slow progression
21. rate of fibrosis in hepatitis C patients with persistently normal
22. alanine aminotransferase activity. Hepatology 1998;27:568–
23. Inglesby TV, Rai R, Astemborski J, et al. A prospective
24. community-based evaluation of liver enzymes in individuals
25. with hepatitis C after drug use. Hepatology 1999;29:590–6.
26. Kenny-Walsh E. Clinical outcomes after hepatitis C infection
27. from contaminated anti-D immune globulin. The Irish
28. Hepatology Research Group. N Engl J Med 1999;340:1228–
29. Hoofnagel JH. Hepatitis C: the clinical spectrum of disease.
30. Hepatology 1997;26(Suppl 1):15–20.
31. Chang C, Ko Y, Liu H. Serum alanine aminotransferase
32. levels in relation to hepatitis B and C virus infections among
33. drug abusers in an area hyperendemic for hepatitis B. Dig
34. Dis Sci 2000;45:1949-52.
35. Fontana R, Lok A. Noninvasive monitoring of patients with
36. chronic hepatitis C. Hepatology 2002;36:S57-64.
37. Imperiale T, Said A, Cummings O, Born L. Need for
38. validation of clinical decision aids: Use of the AST/ALT
39. ratio in predicting cirrhosis in chronic hepatitis C. Am J
40. Gastroenterol 2000;95:2328-32.
41. Park G, Lin B, Ngu M, Jones D, Kateralis P. Aspartateaminotransferase: alanine aminotransferase ratio in chronic
42. hepatitis C infection: Is it a useful predictor of cirrhosis? J
43. Gastroenterol Hepatol 2000;15:386-90.
44. Sheth SG, Glamm SL, Gordon FD, Chopra S. AST/ALT ratio
45. predicts cirrhosis in patients with chronic hepatitis C virus
46. infection. Am J Gastroenterol 1998;93:44-8.
47. Giannini E, Botta F, Fasoli A, et al. Progressive liver
48. functional impairment is associated with an increase in AST/
49. ALT ratio. Dig Dis Sci 1999;44:1249–53.
50. Friedman LS, Dienstag JL, Watkins E, et al. Evaluation of
51. blood donors with elevated serum alanine aminotransferase
52. levels. Ann Intern Med 1987; 107:137-44.
53. Hay JE, Czaja AJ, Rakela J, Ludwig J. The nature of
54. unexplained chronic aminotransferase elevations of a mild
55. to moderate degree in asymptomatic patients. Hepatology
56. 9:193-7.
57. McCormick SE, Goodman ZD, Maydonovitch CL, Sjogren
58. MH. Evaluation of liver histology, ALT elevation, and
59. HCV RNA titer in patients with chronic hepatitis C. Am J
60. Gastroenterol 1996; 91:1516-22.
61. Gobel T, Erhardt A, Herwig M, et al. High prevalence of
62. significant liver fibrosis and cirrhosis in chronic hepatitis
63. B patients with normal ALT in central Europe. J Med Virol
64. 83:968-73.
65. Lu SN, Wang JH, Liu SL, et al. Thrombocytopenia as a
66. surrogate for cirrhosis and a marker for the identification of
67. patients at high-risk for hepatocellular carcinoma. Cancer
68. 107:2212-22.
69. Wai CT, Greenson JK, Fontana RJ, et al. A simple
70. noninvasive index can predict both significant fibrosis and
71. cirrhosis in patients with chronic hepatitis C. Hepatology
72. 38:518-26.
73. Forns X, Ampurdanes S, Llovet JM, et al. Identification of
74. chronic hepatitis C patients without hepatic fibrosis by a
75. simple predictive model. Hepatology 2002; 36(4 Pt 1):986-
76. Bitetto D, Fattovich G, Fabris C, et al. Complementary role
77. of vitamin D deficiency and the interleukin-28B rs12979860
78. C/T polymorphism in predicting antiviral response in chronic
79. hepatitis C. Hepatology 2011; 53:1118-26.
80. Lange CM, Bojunga J, Ramos-Lopez E, et al. Vitamin D
81. deficiency and a CYP27B1–1260 promoter polymorphism
82. are associated with chronic hepatitis C and poor response to
83. interferon-alfa based therapy. J Hepatol 2011; 54:887-93.
84. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum
85. level is related to severe fibrosis and low responsiveness to
86. interferon-based therapy in genotype 1 chronic hepatitis C.
87. Hepatology 2010; 51:1158-67.
88. Brau N. Evaluation of the Hepatitis C Virus–Infected Patient
89. The Initial Encounter. Viral Hepatitis 2013;56:853-60.
90. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to
91. predict survival in patients with end-stage liver disease.
92. Hepatology 2001; 33: 464-70.
93. EASL Clinical Practice Guidelines. Manage- ment of chronic
94. hepatitis B. Association for the Study of the Liver. J Hepatol
95. 57:167-185.
96. ChanHL, WongGL, WongVW. A review of the natural history
97. of chronic hepatitis B in the era of transient elastography.
98. Antivir Ther 2009;14:489-99.
99. Sharifi Z. Natural history of chronic hepatitis B virus
100. infection based on laboratory testing. Iranian J Publ Health
101. 7:990-3.
102. Recommendations for the identification of chronic hepatitis
103. C virus infection among persons born during 1945-1965.
104. MMWR Recomm Rep 2012; 61(RR-4):1–32.
105. David T Arnold DT, Bentham LM, Jacob RP, Lilford RJ
106. Girling AJ. Should patients with abnormal liver function
107. tests in primary care be tested for chronic viral hepatitis: cost
108. minimisation analysis based on a comprehensively tested
109. cohort. BMC Family Practice 2011; 12:9-22.
110. Heidelbaugh JJ, Bruderly AM. Cirrhosis and Chronic Liver
111. Failure: Part I. Diagnosis and Evaluation. Am Fam Physician
112. 74: 756-62.
113. Van Ness MM, Diehl AM. Is liver biopsy useful in the
114. evaluation of patients with chronically elevated liver
115. enzymes? Ann Intern Med 1989;111:473–8.
116. Kundrotas LW, Clement DJ. Serum alanine aminotransferase
117. (ALT) elevation in asymptomatic US Air Force basic trainee
118. blood donors. Dig Dis Sci 1993;38:2145-50.
119. de Franchis R, Meucci G, Vecchi M, et al. The natural history
120. of asymptomatic hepatitis B surface antigen carriers. Ann
121. Intern Med 1993;118:191-4.
122. Lok AS, Ghany MG, Watson G, Ayola B. Predictive value
123. of aminotransferase and hepatitis B virus DNA levels on
124. response to interferon therapy for chronic hepatitis B. J Viral
125. Hepat 1998;5:171-8.
126. Lai CL, Chien RN, Leung NW, et al. A one-year trial
127. of lamivudine for chronic hepatitis B. N Engl J Med
128. 339:61-8.