Comparison of pathological characteristics in patients with non-alcoholic fatty liver disease under diverse alanine transaminase upper limits of normal

Abstract

Abstract Background Non-alcoholic fatty liver disease (NAFLD) patients with elevated serum alanine transaminase (ALT) level are more likely to undergo a liver biopsy for evaluating possible nonalcoholic steatohepatitis (NASH) or significant fibrosis.However,patients with normal ALT could also have advanced stages of NAFLD.This study aimed to explore whether using lower ALT upper limit could reduce missed diagnosis of NASH or significant fibrosis in NAFLD patients. Methods Two hundred and eighty-one NAFLD patients who underwent liver biopsy were enrolled in this cross-sectional study.Student t test and Mann Whitney U test were used for the comparison;the prediction value was evaluated with receiver operating characteristic curve and restricted cubic spline;multiple logistic regression analysis was used to explore the association. Results Among these 281 patients,190 (67.6%) had NASH or significant fibrosis,and had higher ALT [84.00 (43.75,139.50) vs. 39.00 (22.00,64.00) U/L,U = 4872.000,P < 0.001] than Patients without.Using frequently-used ALT upper limit (50 U/L for male and 40 U/L for female) will miss diagnosis 24.7% of NASH or significant fibrosis patients.Using lower ALT upper limit (30 U/L for male and 19 U/L for female) will miss diagnosis 6.3% of patients. Conclusion The use of lower ALT upper limit (30 U/L for male and 19 U/L for female) could significantly reduce missed diagnosis of NASH or significant fibrosis.