title: High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe.
abstract: The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a nonendemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf,Germany over the past 19 years (1990–2009) were evaluated. Thirty-nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 x ULN (upper limit of normal) and 128 patients had ALT >2 x ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2)was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥ 40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis.Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis.
authors.affiliation: Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Göbel
authors.forename: Andreas
authors.initials: A
authors.lastname: Erhardt
authors.forename: Mathias
authors.initials: M
authors.lastname: Herwig
authors.forename: Christopher
authors.initials: C
authors.lastname: Poremba
authors.forename: Stephan Ernst
authors.initials: SE
authors.lastname: Baldus
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Sagir
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heinzel-Pleines
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology / Q000472:pathogenicity*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase