title: Disease progression in Chinese chronic hepatitis C patients with persistently normal alanine aminotransaminase levels.
abstract: BACKGROUND
  Although chronic hepatitis C virus-infected patients with persistently normal alanine aminotransaminase levels usually have mild liver disease, disease progression can still occur. However, it is uncertain which group of patients is at risk of disease progression.
  
  
  OBJECTIVE
  To examine the severity of liver disease on liver biopsy in Chinese patients with persistently normal alanine aminotransaminase levels, and their disease progression over time.
  
  
  METHODS
  Eighty-two patients with persistently normal alanine aminotransaminase levels were followed up longitudinally. The median time of follow-up was 8.1 years. Forty-seven of the 82 patients (57.3%) had a second liver biopsy.
  
  
  RESULTS
  At the time of analysis, six of the 82 patients (7.3%) developed decompensated liver cirrhosis. Patients with an initial fibrosis stage F2 or F3 [6/23 (26.1%) vs. 0/59 (0%), P < 0.0001] or inflammatory grade A2 or A3 [5/40 (12.5%) vs. 1/42 (2.4%), P = 0.04] were more likely to develop decompensated liver cirrhosis. On multivariate analysis, initial fibrosis stage F2 or F3 was independently associated with progression to decompensated liver cirrhosis (relative risk 2.3, 95% confidence interval 0.03-2.5, P = 0.02).
  
  
  CONCLUSIONS
  Chinese chronic hepatitis C virus patients with persistently normal alanine aminotransaminase levels with moderate to severe fibrosis at initial evaluation are more likely to develop decompensated liver cirrhosis.
authors.affiliation: Department of Medicine, Queen Mary Hospital, and Research Centre of Infection and Immunity, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China. ckhui@gmail.com
authors.forename: C-K
authors.initials: CK
authors.lastname: Hui
authors.forename: H-Y
authors.initials: HY
authors.lastname: Zhang
authors.forename: T
authors.initials: T
authors.lastname: Shek
authors.forename: H
authors.initials: H
authors.lastname: Yao
authors.forename: Y-H
authors.initials: YH
authors.lastname: Yueng
authors.forename: K-W
authors.initials: KW
authors.lastname: Leung
authors.forename: S-T
authors.initials: ST
authors.lastname: Lai
authors.forename: J-Y
authors.initials: JY
authors.lastname: Lai
authors.forename: N
authors.initials: N
authors.lastname: Leung
authors.forename: G K
authors.initials: GK
authors.lastname: Lau
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism*; D001706:Biopsy; D002681:China / Q000208:ethnology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000201:enzymology* / Q000208:ethnology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000410:Alanine Transaminase