Viral Load and Enzyme Levels Do Not Predict Severity of Liver Disease in HCVSERUM HCV-RNA, ALT LEVELS AND AST/ALT RATIO DO NOT PREDICT SEVERITY OF LIVER DISEASE IN CHRONIC HEPATITIS C VIRUS INFECTION Author: DW Reedy, AT Loo, RA Levine. Division of Gastroenterology, SUNY Health Science Center, Syracuse, NY The presence or absence of cirrhosis and the
degree of liver inflammation in chronic HCV infection are criteria
which influence the intent to treat. AST/ALT ratio of >= 1 has
been reported as having a calculated 100% positive predictive value
for cirrhosis (Gastroenterology 1996; 110: A1322). If the need for
a liver biopsy could be obviated and the severity of liver disease
predicted based on defined clinical and biochemical parameters,
then the cost of health care could be reduced. Methods: We evaluated 89 patients, including
18 cirrhotics, to determine if the degree of liver inflammation and
presence of cirrhosis could be predicted based solely on
correlation with serum HCV-RNA, ALT and AST levels. All patients
denied heavy alcohol use within 4 months of evaluation. Using a
modified Knodell score, hepatic activity index (HAI), reflecting
histologic inflammation (summation of labour, periportal and portal
inflammation), was graded by 2 investigators who assessed the
biopsies blinded. HAI was correlated by linear regression with ALT,
AST, and HCV-RNA levels, the latter determined by quantitative PCR
(AMPLICOR-Roche). Results: In noncirrhotics vs cirrhotics,
there was no significant difference between mean ALT (173 vs 161),
AST (103 vs 139) and HCV-RNA (560,765 vs 531,994) levels,
respectively (Student t test). Mean HAI was significantly lower in
the cirrhotic (HAI = 6.2) vs the noncirrhotic group (HAI = 7.9, P
< 0.02). There was no correlation between HAI and HCV-RNA, ALT
and AST levels within either the noncirrhotic or cirrhotic groups.
AST/ALT ratio in noncirrhotics was <= 1 in 57/60 and >= 1 in
only 3/60. In cirrhotics, AST/ALT ratio was <= 1 in 11/18 and
>= 1 in 7/18 patients. The positive predictive value of a ratio
>= 1 for cirrhosis was only 69%. Conclusions: Our results show that AST/ALT ratio, although specific for the presence of cirrhosis, had only a modest positive predictive value and should not be the sole determinant to identify cirrhosis. Liver biopsy should be performed prior to treatment of chronic HCV infection, since HCV-RNA, ALT and AST levels fail to predict accurately the severity of liver inflammation or the presence of cirrhosis. Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting |
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