1. AST/ALT ratio is not an index of liver fibrosis in chronic hepatitis C when aminotransferase activities are determinate according to the international recommendations
- Author
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Jérôme, Guéchot, Renée Claude, Boisson, Jean-Pierre, Zarski, Nathalie, Sturm, Paul, Calès, Elisabeth, Lasnier, E-S, Zafrani, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Biochimie et Toxicologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Pôle Digidune, Pôle DigiDune, Laboratoire de Cytologie, Département d'Anatomie et de Cytologie Pathologiques, CHU Grenoble-Hôpital Michallon, Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), and Université d'Angers (UA)
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Organ Dysfunction Scores ,Biopsy ,[SDV]Life Sciences [q-bio] ,Biopsy, Fine-Needle ,Gastroenterology ,digestive system ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Aspartate Aminotransferases ,Prospective Studies ,Pyridoxal phosphate ,Chronic ,Prospective cohort study ,Pyridoxal ,Hepatology ,medicine.diagnostic_test ,business.industry ,AST/ALT ratio ,Alanine Transaminase ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Hepatitis C ,digestive system diseases ,3. Good health ,chemistry ,Liver ,ROC Curve ,030220 oncology & carcinogenesis ,Liver biopsy ,Pyridoxal Phosphate ,Cohort ,Fine-Needle ,030211 gastroenterology & hepatology ,Female ,business ,Hepatic fibrosis - Abstract
International audience; OBJECTIVE: The aspartate aminotransferase activity (AST)/alanine aminotransferase activity (ALT) ratio is used as liver fibrosis index whereas the reported data are conflicting. In chronic hepatitis C (CHC), reported diagnostic accuracies range from none to good for significant fibrosis and to excellent for cirrhosis. Assuming that AST/ALT increases are mainly due to vitamin B6 defects since pyridoxal phosphate (PLP), active form of B6, acts as coenzyme in transamination reactions, we evaluated the diagnostic accuracy of the AST/ALT ratio using standardized methods for AST and ALT activities, with PLP addition as recommended, in a prospective multicenter cohort of CHC patients.METHODS: ALT and AST activities were measured using the recommended IFCC methods with addition of pyridoxal 5'-phosphate. We evaluated the AST/ALT ratio for the diagnosis of liver fibrosis or cirrhosis in a cohort of CHC patients included in a multicenter prospective study. A liver biopsy was performed in each patient and reviewed by two independent pathologists in order to determine the fibrosis stage according to Metavir classification which was the reference standard.RESULTS: AST/ALT ratio significantly increased with histological stage of liver fibrosis and there was a significant correlation between Metavir fibrosis stage and AST/ALT ratio (r=0.129, PCONCLUSION: AST/ALT ratio is not a good and discriminative index of liver fibrosis in CHC when aminotransferase activities are determinate according to the international recommendations.
- Published
- 2013
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