[ALT screening for chronic liver diseases: scrutinizing the evidence].
Elevated serum amino-transferase levels may be associated with liver injury. Testing for aspartate aminotransferase (AST) or alanine aminotransferase (ALT) is part of many routine screening approaches. The aim of this manuscript was to scrutinize the evidence for using ALT testing as a primary screening parameter for liver diseases. We conclude that (i) elevated serum ALT levels indicate a high specificity and a reasonable sensitivity liver injury, (ii) 10 - 25 % of German adults have elevated ALT levels, (iii) ALT values are increased in the majority but not all patients with acute and chronic liver disease (iv) elevated ALT-values are associated with an increased risk of liver-specific mortality, (v) elevated ALT values are also a risk factor for non-hepatic diseases including diabetes mellitus type 2, metabolic syndrome, cardiovascular diseases and malignancies, (vi) many liver diseases identified by an ALT screening can be treated successfully including prevention of development of clinical endpoints, (vii) an ALT-screening is very likely to be cost-effective although studies are needed for Germany to support this conclusion.
Wedemeyer
H
H
Klinik für Gastroenterologie, Hepatologie and Endokrinologie, Medizinische Hochschule Hannover. Wedemeyer.Heiner@mhhannover.de
Hofmann
W P
WP
Lueth
S
S
Malinski
P
P
Thimme
R
R
Tacke
F
F
Wiegand
J
J
D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D002908:Chronic Disease; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000191:economics; D005858:Germany; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008111:Liver Function Tests / Q000191:economics; D008403:Mass Screening / Q000191:economics; D009313:National Health Programs / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase