Optimal ALT threshold for the automated diagnosis of MASLD: A population-based study using iLFT.

Autor:	Lee J; School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. Electronic address: j.j.s.lee@dundee.ac.uk., Byrne CJ; Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK., Brennan PN; Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK., MacPherson I; Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK., Dow E; Department of Blood Sciences, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK., Dillon JF; Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.
Jazyk:	angličtina
Zdroj:	Annals of hepatology [Ann Hepatol] 2024 Mar-Apr; Vol. 29 (2), pp. 101280. Date of Electronic Publication: 2024 Jan 14.
DOI:	10.1016/j.aohep.2023.101280
Abstrakt:	Introduction and Objectives: Early diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), especially with advanced fibrosis, is crucial due to the increased risk of complications and mortality. Serum alanine aminotransferase (ALT) is commonly used; however, many patients have normal ranges (<55 U/L) who may remain undetected. We investigated the clinical implications of a lower ALT cut-off (>30 U/L) using intelligent liver function testing (iLFT) to identify MASLD patients with and without advanced fibrosis in primary care. Materials and Methods: All patients entering the iLFT diagnostic pathway had liver aetiological screening investigations if ALT >30 U/L. In those with MASLD the proportions with and without advanced fibrosis at different ALT thresholds: 31-41 U/L, 42-54 U/L and ≥55 U/L were compared. Results: 16,373 patients underwent iLFT between March 2016 to April 2022. 762 (5 %) patients had MASLD with abnormal fibrosis scores, while 908 (6 %) had MASLD with normal fibrosis scores. 428 (56 %) patients were assessed in liver clinics, where 169 (39 %) had evidence of fibrosis. Of these, 22 (13 %) had ALT 31-41 U/L, 31 (18 %) had ALT 42-54 U/L and 116 (69 %) had ALT ≥55 U/L. 145 (86 %) patients had advanced fibrosis or cirrhosis, where 20 (14 %) had ALT 31-41 U/L, 28 (19 %) had ALT 42-54 U/L and 97 (67 %) had ALT ≥55 U/L. Conclusions: 33 % of MASLD patients with advanced fibrosis or cirrhosis had ALT 31-54 U/L, who would have been missed using the conventional ALT range. This suggests that lowering the ALT cut-off improves diagnosis of MASLD with advanced fibrosis in primary care. Competing Interests: Conflicts of interest JL Declarations of interest: none; CJB Declarations of interest: none; PNB has consulted for Resolution Therapeutics and received educational honoraria from Takeda; IMcP Declarations of interest: none; ED declares educational grants from Siemens and Abbott unrelated to the submitted work; JFD reports grants and personal fees from AbbVie; grants and personal fees from Gilead; and grants and personal fees from MSD, outside the submitted work. (Copyright © 2024 Fundación Clínica Médica Sur, A.C. All rights reserved.)
Databáze:	MEDLINE
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