title: Significant prevalence of histologic disease in patients with chronic hepatitis B and mildly elevated serum alanine aminotransferase levels.
abstract: OBJECTIVE
  Serum ALT remains the most accessible test available to clinicians for monitoring chronic hepatitis B virus infection, but appropriate action when ALT levels are only mildly elevated is ambiguous in standard guidelines.
  
  
  METHODS
  A retrospective study was conducted to investigate the prevalence of significant histology in a patient population with mildly elevated serum ALT levels. A total of 193 consecutive patients were selected and divided into 2 groups according to HBeAg status. Patients were further divided into cohorts on the basis of their highest ALT elevation during follow-up and whether it was 1-1.5 times the upper limit of normal (ULN), 1.5-2 times the ULN, or greater than twice the ULN. The ULN that was used is 30 U/L for men and 19 U/L for women.
  
  
  RESULTS
  In all cohorts there was a substantial fraction of patients with histologic disease as evaluated by liver biopsy. HBeAg-negative patients were older, had lower viral load, and had a higher prevalence of disease. After adjustments for age, HBeAg status and HBV DNA viral load were not predictors of significant histology. Age >35 years, male gender, and increasing ALT levels were predictors for significant histology on multivariate analysis.
  
  
  CONCLUSIONS
  A substantial proportion of patients with mildly elevated ALT levels have significant histologic disease. The prevalence increased with the higher ALT levels and age.
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Philip S Y
authors.initials: PS
authors.lastname: Tsang
authors.forename: Huy
authors.initials: H
authors.lastname: Trinh
authors.forename: Ruel T
authors.initials: RT
authors.lastname: Garcia
authors.forename: Jeanine T
authors.initials: JT
authors.lastname: Phan
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.forename: Huy
authors.initials: H
authors.lastname: Nguyen
authors.forename: Khanh
authors.initials: K
authors.lastname: Nguyen
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000410:Alanine Transaminase / Q000097:blood*; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000201:enzymology / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D006514:Hepatitis B Surface Antigens; D000410:Alanine Transaminase