Transaminases and gamma glutamyl transpeptidase for detecting nonalcoholic steatohepatitis and fibrosis in nonalcoholic fatty liver disease

Abstract

<p><strong>Background:</strong> Nonalcoholic steatohepatitis (NASH) and advanced fibrosis are the spectrum of nonalcoholic fatty liver disease (NAFLD) that may progress to cirrhosis.</p><p><strong>Objective:</strong> We aimed to determine the detecting capacity of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT) for NASH and <br />significant fibrosis.</p><p><strong>Methods:</strong> Demographic and laboratory data of 502 sonologically diagnosed NAFLD patients were retrospectively analysed. Area under receiver operating characteristics curve (AUROC) was performed for NASH and fibrosis score ≥2 (significant fibrosis) with ALT, AST and GGT of 233 biopsied patients.</p><p><strong>Results:</strong> Of 502 patients ALT, AST and GGT was elevated in 252 (50.1 %), 184 (36.7%) and 138 (27.4%) respectively. There was no difference in histological activity and fibrosis score between normal and elevated ALT and AST. Forty two (40.2%) NASH and 23(20.2%) significant fibrosis had normal ALT level. GGT was differed in NASH and Non NASH (p< .005) and between significant fibrosis (p< .01) and insignificant fbrosis. To detect NASH AUROC curve ofGGT was 67.5%, whereas of ALT and AST was 55.2% and 55.7%. For significant fibrosis AUROC curve of ALT, AST and GGT was 44, 50 and 68.4 % respectively. GGT level of39.5 U/L could detect NASH with a 63% sensitivity and 65% specificity irrespective of sex. GGT 40.5U/L had 60% sensitivity and 59 % specificity to detect significant fibrosis. For fibrosis ≥2 AUROC curve was 75.4% in male.</p><p><strong>Conclusion:</strong> No optimal ALT and AST level could detect NASH and fibrosis. GGT level of 40 U/L had a better detecting capacity for NASH and fibrosis especially in male. </p>