Alanine aminotransferase is an inadequate surrogate marker for detecting lamivudine resistance
| Autor: | Seng Gee Lim, Evelyn Siew-Chuan Koay, Cindy Tan, Guan Huei Lee, Yin Mei Lee, Myat Oo Aung, Yock Young Dan, Bee Leng Seet, Lee Guan Lim, Mark L. Fernandes, Dede Selamat Sutedja |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Hepatitis B virus medicine.medical_specialty Brief Article Drug resistance medicine.disease_cause digestive system Antiviral Agents Sensitivity and Specificity Likelihood ratios in diagnostic testing Gastroenterology Hepatitis B Chronic Blood serum Asian People Internal medicine Drug Resistance Viral medicine Humans Retrospective Studies biology medicine.diagnostic_test business.industry Lamivudine Alanine Transaminase General Medicine Middle Aged Hepatitis B medicine.disease digestive system diseases Alanine transaminase DNA Viral Immunology biology.protein business Liver function tests Biomarkers medicine.drug |
| Zdroj: | World Journal of Gastroenterology. 16:4691 |
| ISSN: | 1007-9327 |
| Popis: | AIM: To investigate the accuracy of serum alanine aminotransferase (ALT) in diagnosing lamivudine resistance and factors that contributed to abnormal serum ALT. METHODS: This was a retrospective study of chronic hepatitis B patients on lamivudine therapy who were followed for 3-mo with liver function tests and hepatitis B virus (HBV) DNA measurement. Lamivudine resistance was defined as HBV DNA ≥ 1 log from nadir on at least 2 occasions, confirmed by genotyping. Serum ALT levels in patients with lamivudine resistance were compared to serum ALT levels in those without lamivudine resistance. RESULTS: There were 111 patients with and 117 without lamivudine resistance. The area under the receiver operating characteristic of serum ALT to diagnose lamivudine resistance was 0.645 ± 0.037. Serum ALT > 42.5 U/L gave the best diagnostic accuracy with sensitivity = 61%, specificity = 60%, positive predictive value = 60%, negative predictive value = 61%, positive likelihood ratio = 1.53 and negative likelihood ratio = 0.65 for predicting lamivudine resistance, missing 39% of resistant patients. Using other serum ALT cutoffs, diagnostic accuracy was lower. By multivariate analysis, baseline abnormal serum ALT was associated with abnormal ALT during resistance (OR = 5.98, P = 0.003), and males were associated with serum ALT flares during resistance (OR = 8.9, P = 0.016). CONCLUSION: Serum ALT is inadequate for diagnosing lamivudine resistance and has implications where viral resistance testing is suboptimal and for reimbursement of rescue therapy. |
| Databáze: | OpenAIRE |
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