These first two authors contributed equally to this study.
Upper normal threshold of serum alanine aminotransferase in identifying individuals at risk for chronic liver disease
Article first published online: 20 JAN 2012
© 2012 John Wiley & Sons A/S
Volume 32, Issue 6, pages 937–944, July 2012
How to Cite
Park, H. N., Sinn, D. H., Gwak, G.-Y., Kim, J. E., Rhee, S. Y., Eo, S. J., Kim, Y. J., Choi, M. S., Lee, J. H., Koh, K. C., Paik, S. W. and Yoo, B. C. (2012), Upper normal threshold of serum alanine aminotransferase in identifying individuals at risk for chronic liver disease. Liver International, 32: 937–944. doi: 10.1111/j.1478-3231.2011.02749.x
- Issue published online: 6 JUN 2012
- Article first published online: 20 JAN 2012
- Manuscript Accepted: 28 DEC 2011
- Manuscript Received: 10 OCT 2011
- Samsung Biomedical Research Institute. Grant Number: #SBRI C-B1-117-1
- alanine aminotransferase;
- chronic liver disease;
Serum alanine aminotransferase (ALT) is an easily available, low-cost screening tool for detecting silent chronic liver disease. Recent studies have suggested that the currently accepted healthy ALT thresholds be lowered.
In this retrospective cross-sectional study, we determined upper thresholds for ALT values in a nationally representative healthy cohort (n = 3337) from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Sensitivity and specificity of the currently used ALT threshold (40 IU/L, regardless of gender) was compared against study-derived, gender-specific ALT thresholds for detecting individuals at risk for chronic liver disease in 27 913 health check-up participants.
The 95th percentile levels for ALT in healthy weight, metabolically normal, liver disease-free KNHANES participants were 34 IU/L for men and 25 IU/L for women. The prevalence of ALT elevation among health check-up participants was 11.0% in currently used thresholds, and increased to 22.6% with study-derived, gender-specific thresholds. Of the population who were additionally defined to have elevated ALT levels under new ALT threshold, 65.7% were at risk for chronic liver disease. Sensitivity for detecting individuals at risk for chronic liver disease improved from 18 to 33% with new thresholds whereas a trade-off in specificity (from 96 to 88%) was observed.
It is recommendable to lower the current ALT thresholds to better identify individuals at risk for chronic liver disease.