Relationship between serum alanine aminotransferase levels and liver histology in chronic hepatitis C-infected patients.

BACKGROUND The efficacy of serum alanine aminotransferase (ALT) levels in predicting the severity of hepatitis C virus (HCV) infection is unclear. OBJECTIVE To compare histologic scoring of liver pathology in patients with chronic HCV infection with normal or elevated serum ALT. METHODS Liver biopsies were performed in patients with HCV infection and either normal (n=40) or elevated (n=76) serum ALT levels, and scored for activity and fibrosis using the modified histological activity index. RESULTS Patients with normal ALT and elevated ALT had similar demographic features. Median (range) histological activity grade was higher in patients with elevated ALT than in those with normal ALT (6 [1-15] vs. 5 [0-11], respectively; p=0.001), as was the fibrosis stage (2 [0-6] vs. 1[0-6]; p=0.02). Two patients with normal ALT and 4 with elevated ALT had liver cirrhosis. CONCLUSIONS Among patients with chronic HCV infection, liver lesions are milder in those with normal serum ALT levels than those with abnormal ALT levels. However, some patients with normal ALT too may have advanced liver disease.