title: Diagnostic and predictive factors of significant liver fibrosis and minimal lesions in patients with persistent unexplained elevated transaminases. A prospective multicenter study.
abstract: OBJECTIVE
  In patients with unexplained elevated transaminases, prognosis of the liver disease and factors associated with increased risk of liver fibrosis and normal/subnormal liver are unknown. The aim of this prospective study was to identify diagnosis and clinical and biological factors associated with significant (bridging) fibrosis and minimal lesions of the liver in patients with persistent unexplained elevated ALT levels.
  
  
  METHODS
  From July 2002 through October 2004, all consecutive asymptomatic patients with unexplained chronically elevated ALT levels were included. All patients had clinical, biological, ultrasonographic examination and a liver biopsy.
  
  
  RESULTS
  272 patients (60.3% males, mean age 46.4 years, BMI 26.7) were included. Pathological findings were: minimal lesions (18.7%), steatosis (26.8%), NASH (32.7%), and miscellaneous (21.7%). Significant fibrosis was found in 27.4% of cases, including 9 cases of cirrhosis. By multivariate analysis, independent predictors of significant fibrosis were tobacco use (OR 2.5, 95% CI 1.34-4.74 p=0.04), BMI>25 (2.49, 1.31-4.73 p=0.005) and diabetes (4.41, 1.73-11.29 p=0.002). Independent factors associated with minimal lesions were female gender (OR 3.4 95% CI 1.73-6.75 p<0.0001) and BMI<25 (3.55, 1.8-6.98, p<0.0001).
  
  
  CONCLUSIONS
  In patients with unexplained chronically elevated transaminases, significant fibrosis is statistically associated with tobacco use, BMI>25 and diabetes, and minimal lesions are significantly associated with female gender and BMI<25.
authors.affiliation: Service d'Hépato-Gastroentérologie, Hôpital du Haut-Lévêque, Pessac, France. victor.deledinghen@chu-bordeaux.fr
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Xavier
authors.initials: X
authors.lastname: Causse
authors.forename: Brigitte
authors.initials: B
authors.lastname: Le Bail
authors.forename: Dominique
authors.initials: D
authors.lastname: Capron
authors.forename: Christophe
authors.initials: C
authors.lastname: Renou
authors.forename: Christophe
authors.initials: C
authors.lastname: Pilette
authors.forename: Valérie
authors.initials: V
authors.lastname: Oules
authors.forename: Eve
authors.initials: E
authors.lastname: Gelsi
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Anaïs
authors.initials: A
authors.lastname: Vallet-Pichard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Le Provost
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D005234:Fatty Liver / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase