Liver function tests in chronic viral hepatitis cases

Year 2016, Special Issue :2 Gastroenterology and Hepatology Viral Hepatitis, 6 - 9, 01.08.2016

Goncagül Haklar

https://doi.org/10.5472/MMJsi.2901.03

Cited By: 2

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

• Burtis CA, Ashwood ER, Bruns D (editors). Tietz Textbook
• of Clinical Chemistry and Molecular Medicine. St. Louis
• Elsevier Saunders, 2006: 1777-847.
• Dufour D, Lott J, Nolte F, et al. Diagnosis and monitoring
• of hepatic injury. II. Recommendations for use of laboratory
• tests in screening, diagnosis, and monitoring. Clin Chem
• 46:2050-68.
• Dincer D, Okten A, Kaymakoglu S, et al. Persistantly normal
• alanine transaminase levels in chronic C hepatitis: What does
• it tell us? Hepatogastroenterology 2001;48:1397-400.
• Mofrad P, Contos M, Haque M, et al. Clinical and histologic
• spectrum of nonalcoholic fatty liver disease associated with
• normal ALT values. Hepatology 2003;37:1286-92.
• Dufour DR. Alanine aminotransferase variation in chronic
• hepatitis C infection: An analysis of 357 cases. Clin Chem
• 47:A26-A7.
• Alter HJ, Conry-Cantilena C, Melpolder J, et al. Hepatitis C
• in asymptomatic blood donors. Hepatology 1997;26(Suppl
• 29–33.
• Mathurin P, Moussalli J, Cadranel J-F, et al. Slow progression
• rate of fibrosis in hepatitis C patients with persistently normal
• alanine aminotransferase activity. Hepatology 1998;27:568–
• Inglesby TV, Rai R, Astemborski J, et al. A prospective
• community-based evaluation of liver enzymes in individuals
• with hepatitis C after drug use. Hepatology 1999;29:590–6.
• Kenny-Walsh E. Clinical outcomes after hepatitis C infection
• from contaminated anti-D immune globulin. The Irish
• Hepatology Research Group. N Engl J Med 1999;340:1228–
• Hoofnagel JH. Hepatitis C: the clinical spectrum of disease.
• Hepatology 1997;26(Suppl 1):15–20.
• Chang C, Ko Y, Liu H. Serum alanine aminotransferase
• levels in relation to hepatitis B and C virus infections among
• drug abusers in an area hyperendemic for hepatitis B. Dig
• Dis Sci 2000;45:1949-52.
• Fontana R, Lok A. Noninvasive monitoring of patients with
• chronic hepatitis C. Hepatology 2002;36:S57-64.
• Imperiale T, Said A, Cummings O, Born L. Need for
• validation of clinical decision aids: Use of the AST/ALT
• ratio in predicting cirrhosis in chronic hepatitis C. Am J
• Gastroenterol 2000;95:2328-32.
• Park G, Lin B, Ngu M, Jones D, Kateralis P. Aspartateaminotransferase: alanine aminotransferase ratio in chronic
• hepatitis C infection: Is it a useful predictor of cirrhosis? J
• Gastroenterol Hepatol 2000;15:386-90.
• Sheth SG, Glamm SL, Gordon FD, Chopra S. AST/ALT ratio
• predicts cirrhosis in patients with chronic hepatitis C virus
• infection. Am J Gastroenterol 1998;93:44-8.
• Giannini E, Botta F, Fasoli A, et al. Progressive liver
• functional impairment is associated with an increase in AST/
• ALT ratio. Dig Dis Sci 1999;44:1249–53.
• Friedman LS, Dienstag JL, Watkins E, et al. Evaluation of
• blood donors with elevated serum alanine aminotransferase
• levels. Ann Intern Med 1987; 107:137-44.
• Hay JE, Czaja AJ, Rakela J, Ludwig J. The nature of
• unexplained chronic aminotransferase elevations of a mild
• to moderate degree in asymptomatic patients. Hepatology
• 9:193-7.
• McCormick SE, Goodman ZD, Maydonovitch CL, Sjogren
• MH. Evaluation of liver histology, ALT elevation, and
• HCV RNA titer in patients with chronic hepatitis C. Am J
• Gastroenterol 1996; 91:1516-22.
• Gobel T, Erhardt A, Herwig M, et al. High prevalence of
• significant liver fibrosis and cirrhosis in chronic hepatitis
• B patients with normal ALT in central Europe. J Med Virol
• 83:968-73.
• Lu SN, Wang JH, Liu SL, et al. Thrombocytopenia as a
• surrogate for cirrhosis and a marker for the identification of
• patients at high-risk for hepatocellular carcinoma. Cancer
• 107:2212-22.
• Wai CT, Greenson JK, Fontana RJ, et al. A simple
• noninvasive index can predict both significant fibrosis and
• cirrhosis in patients with chronic hepatitis C. Hepatology
• 38:518-26.
• Forns X, Ampurdanes S, Llovet JM, et al. Identification of
• chronic hepatitis C patients without hepatic fibrosis by a
• simple predictive model. Hepatology 2002; 36(4 Pt 1):986-
• Bitetto D, Fattovich G, Fabris C, et al. Complementary role
• of vitamin D deficiency and the interleukin-28B rs12979860
• C/T polymorphism in predicting antiviral response in chronic
• hepatitis C. Hepatology 2011; 53:1118-26.
• Lange CM, Bojunga J, Ramos-Lopez E, et al. Vitamin D
• deficiency and a CYP27B1–1260 promoter polymorphism
• are associated with chronic hepatitis C and poor response to
• interferon-alfa based therapy. J Hepatol 2011; 54:887-93.
• Petta S, Camma C, Scazzone C, et al. Low vitamin D serum
• level is related to severe fibrosis and low responsiveness to
• interferon-based therapy in genotype 1 chronic hepatitis C.
• Hepatology 2010; 51:1158-67.
• Brau N. Evaluation of the Hepatitis C Virus–Infected Patient
• The Initial Encounter. Viral Hepatitis 2013;56:853-60.
• Kamath PS, Wiesner RH, Malinchoc M, et al. A model to
• predict survival in patients with end-stage liver disease.
• Hepatology 2001; 33: 464-70.
• EASL Clinical Practice Guidelines. Manage- ment of chronic
• hepatitis B. Association for the Study of the Liver. J Hepatol
• 57:167-185.
• ChanHL, WongGL, WongVW. A review of the natural history
• of chronic hepatitis B in the era of transient elastography.
• Antivir Ther 2009;14:489-99.
• Sharifi Z. Natural history of chronic hepatitis B virus
• infection based on laboratory testing. Iranian J Publ Health
• 7:990-3.
• Recommendations for the identification of chronic hepatitis
• C virus infection among persons born during 1945-1965.
• MMWR Recomm Rep 2012; 61(RR-4):1–32.
• David T Arnold DT, Bentham LM, Jacob RP, Lilford RJ
• Girling AJ. Should patients with abnormal liver function
• tests in primary care be tested for chronic viral hepatitis: cost
• minimisation analysis based on a comprehensively tested
• cohort. BMC Family Practice 2011; 12:9-22.
• Heidelbaugh JJ, Bruderly AM. Cirrhosis and Chronic Liver
• Failure: Part I. Diagnosis and Evaluation. Am Fam Physician
• 74: 756-62.
• Van Ness MM, Diehl AM. Is liver biopsy useful in the
• evaluation of patients with chronically elevated liver
• enzymes? Ann Intern Med 1989;111:473–8.
• Kundrotas LW, Clement DJ. Serum alanine aminotransferase
• (ALT) elevation in asymptomatic US Air Force basic trainee
• blood donors. Dig Dis Sci 1993;38:2145-50.
• de Franchis R, Meucci G, Vecchi M, et al. The natural history
• of asymptomatic hepatitis B surface antigen carriers. Ann
• Intern Med 1993;118:191-4.
• Lok AS, Ghany MG, Watson G, Ayola B. Predictive value
• of aminotransferase and hepatitis B virus DNA levels on
• response to interferon therapy for chronic hepatitis B. J Viral
• Hepat 1998;5:171-8.
• Lai CL, Chien RN, Leung NW, et al. A one-year trial
• of lamivudine for chronic hepatitis B. N Engl J Med
• 339:61-8.