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 17 January 2018

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News

AST/ALT ratio in patients with HCV-related chronic liver disease

Researchers in the latest issue of the Archives of Internal Medicine find that noninvasive evaluation, by means of the combined AST/ALT ratio and platelet count assessment, misclassifies only a few cirrhotic patients.

News image

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The aspartate aminotransferase-alanine aminotransferase ratio (AST/ALT ratio) has been used to assess the severity of disease in patients with chronic liver disease (CLD).

Researchers from Italy have previously demonstrated that progressive liver functional impairment is associated with an increase in the AST/ALT ratio.

In this study, the same research team evaluated:

  1. the reproducibility and transportability of the AST/ALT ratio in a large cohort of patients with different degrees of HCV-related CLD
  2. the correlation between progressive impairment of liver function and increase in the AST/ALT ratio
  3. whether diagnostic accuracy of the ALT/AST ratio can be improved by using it with other biochemical variables
  4. and the 1-year prognostic capability of the AST/ALT ratio in patients with liver cirrhosis.

The researchers retrospectively assessed 252 patients with HCV-related CLD.

The team correlated the AST/ALT ratio with the degree of liver fibrosis in patients with chronic hepatitis, and with the Child-Pugh score in patients with cirrhosis.

All patients had undergone monoethylglycinexylidide (MEGX) testing to evaluate liver function.

The AST/ALT ratio had 81% sensitivity and 55% specificity in identifying patients who died within 1 year.
Archive of Internal Medicine
They also assessed the prognostic ability of the AST/ALT ratio in a subset of 63 cirrhotic patients, who were followed up for at least 1 year.

The researchers found that the AST/ALT ratio was more frequently 1, or higher in cirrhotic patients.

In addition, there was a significant correlation between MEGX values and the AST/ALT ratio.

Multivariate stepwise logistic analysis found that AST/ALT ratio, platelet count (PLT), MEGX values, and prothrombin activity were independently associated with the presence of cirrhosis.

Furthermore, combined assessment of the AST/ALT ratio and/or PLT obtained a 97% positive predictive value, and 98% negative predictive value for the diagnosis of cirrhosis.

The researchers determined that the AST/ALT ratio had 81% sensitivity and 55% specificity in identifying cirrhotic patients who died within 1 year of follow-up.

Dr Edoardo Giannini's team concluded, "The AST/ALT ratio is both reproducible and transportable in patients with HCV-related CLD".

"The AST/ALT ratio is correlated with both histologic stage and clinical evaluation."

"Progressive liver functional impairment is reflected by an increase in the AST/ALT ratio."

"Noninvasive evaluation by means of the combined AST/ALT ratio and PLT assessment misclassifies only a few cirrhotic patients."

"In cirrhotic patients, the AST/ALT ratio provides medium-term prognostic information that is no different from that provided by established prognostic scores."

Arch Intern Med 2003; 163: 218-24
31 January 2003

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