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62

NO ASSOCIATION BETWEEN ALT LEVELS AND LIVER BIOPSY RESULTS IN PATIENTS EVALUATED FOR UNDETERMINED LIVER ENZYME ELEVATION

N Ahmed1, C Holcroft2, A Szilagyi2, E Lamoureux2, N Hilzenrat2

1McGill University; 2Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec
Aims:
To determine if ALT values and statistical measures of variability of ALT correlate with liver biopsy activity and staging in patients with undetermined etiology of liver enzyme abnormalities.
Methods: 25 patients were referred for assessment of elevated liver enzymes of at least 12 months duration, between the years of 2002-2008. The cause of the enzyme abnormalities was not apparent after extensive testing for viral, autoimmune, hereditable and metabolic etiologies. All patients consumed less than 10 g/day on average of alcohol. The ALT values were measured by the same lab for approximately one year before and after liver biopsy. 23 of the patients have had a liver biopsy. The grading and staging of the liver biopsies were assessed by the same pathologist using the Metavir system. The Stata 8.2 statistical package was used to analyze the data.
Results: The age of the subjects at the time of liver biopsy ranged from 26-70 years (mean 43.513.1). 14 (56%) patients were male. The mean follow-up in our centre was 2.71.4 years. The ALT values were 67.526.4 U/L. The percent coefficient of variation (CV) was 98.8%. The grading of the activity was 1 out of 4 in 17 patients (74%). The staging of the fibrosis was 1 out of 4 in 3 patients (13%). The remaining patients did not demonstrate evidence of inflammatory process or fibrosis. The mean TSH level was 1.940.88 mIU/L. Non-parametric Spearman correlation coefficient for ALT and TSH was calculated to be -0.1219. No correlation between ALT levels and liver biopsy grading and staging and TSH level was found. However, patients with high ALT showed tendency toward higher fibrosis stage.
Conclusions: Evaluation of this group of patients with undetermined etiology for elevated liver enzymes, did not demonstrate correlation between the ALT values and inflammation grading or fibrosis staging on liver biopsy. This questions the value of liver enzyme follow-up as a marker for changes in histology status. The level of fibrosis staging remained low after several years of follow-up suggesting a benign course in our cohort.

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