Differences In Alanine Aminotransferase Levels Research Articles

The role of liver transaminase levels in methotrexate intolerance in juvenile idiopathic arthritis—a cross-sectional study

Methotrexate (MTX) plays a key role when treating juvenile idiopathic arthritis (JIA), but MTX-intolerance is challenging. MTX-treatment might affect the liver, causing elevated levels of alanine aminotransferase (ALT), yet the role of ALT-levels in MTX-intolerance in JIA remains unclear. Our study aimed to investigate the association between ALT-levels during MTX-treatment and MTX-intolerance in JIA. Children (> 9years old) diagnosed with JIA and treated with MTX (> 6weeks) were eligible for enrollment. MTX-intolerance was assessed using the Methotrexate Intolerance Severity Score (MISS), completed by the parents, and defined as MISS ≥ 6 with at least 1 point for a behavioral/anticipatory/associative symptom. ALT-levels were determined at enrollment. A total of 118 children were enrolled (80 girls; 38 boys). MTX-intolerance was registered in 61%. ALT-levels did not differ between the MTX-intolerant group (median = 17.0 U/L [IQR: 14.0-26.0]) and the MTX-tolerant group (median = 20.5 U/L [IQR: 16.0-27.5]; p = 0.17). MTX-intolerance was prevalent in around 60% of both boys and girls. Nine out of 50 MTX-intolerant girls had elevated ALT-levels compared to 0/22 MTX-intolerant boys, however, there was no difference in median ALT levels between the two groups. Furthermore, the MTX-intolerant girls had a higher MISS (median = 14.0 [IQR: 9.3-17]) than the MTX-intolerant boys (median = 10.0 [IQR: 7.3-12]; p = 0.009). Our study did not find a difference in ALT-levels between MTX-intolerant and MTX-tolerant children. However, only MTX-intolerant girls and no MTX-intolerant boys showed elevated ALT-levels.

Evulation of prolidase enzyme, and galectin levels as a marker for fibrosis in patients with chronic hepatitis B.

The fibrosis can be detected using non-invasive methods including prolidase activity, proline levels and galectin-3 (GAL-3) detection in the serum. The aim of this study was to investigate the liver fibrosis through non-invasive methods in chronic hepatitis B patients. This prospective case control study includes 56 patients with Chronic Active Hepatitis B (CAHB), 57 patients with Inactive Hepatitis B (IHB), and 60 healthy matched control subjects. The first group included the CAHB [hepatitis B surface antigen (HBsAg): positive; HBV DNA >2,000 IU/mL; normal or high alanine aminotransferase (ALT) value] undergo a liver biopsy, while the second group included the IHB (HBsAg: positive; HBV DNA: negative; normal ALT value). The third group comprised the healthy controls. Serum prolidase enzyme activities (SPEA), proline and galectin-3 levels were measured for each group. Patients with CAHB had significantly higher SPEA levels (1,004.3±186.8 IU/L) than did the controls (196.5±306 IU/L) (p<0.001). Significantly higher serum GAL-3 levels were found in the CHB group compared with HBV carrier and the control groups (27.4±32.2 ng/mL, 6.5±13.4 ng/mL, 3.1±5.7 ng/mL, respectively, p<0.001). The relationship between serum prolidase activity, hidroxiprolyne and fibrosis (p<0.05). There were no significant differences in ALT levels between inactive HBV carriers and the control groups (p>0.05). We suppose that hidroxiprolyne levels and prolidase enzyme activity might be an indicator as a marker for fibrosis in CAHB and the evaluation of response to treatment.

The Effect of Paracetamol and Codeine Analgesic Combination on Serum Alanine Aminotransferase and Aspartate Aminotransferase Levels in Male Wistar Rats

BACKGROUND: Paracetamol and codeine are classified as different analgesic categories with different mechanism. The combination of both paracetamol and codeine as an analgesic works synergistically and may give better outcome in pain management in moderate-to-severe degree. However, the combination of those analgesics might bring side effects in liver. AIM: This study was to determine the effect of analgesic combination of paracetamol and codeine on alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of Wistar rats. METHODS: This study was an experimental study with a pre- and post-test control group design. The study objects were 20 male Wistar rats with certain criteria, which were randomly divided into four groups, that is, control group (C), group with paracetamol therapy alone (32 mg/kgBW), group with codeine therapy alone (1.9 mg/kgBW), and group with combination therapy of paracetamol (32 mg/kgBW) and codeine (1.9 mg/kgBW). Analgesic drugs were administered orally 4 times a day for 28 days with gastric sonde. On the 29th day, blood samples were collected through retro-orbital blood vessels for measuring ALT and AST levels. Statistical tests used were one-way ANOVA and Kruskal–Wallis test. RESULTS: They showed that there were no differences in ALT levels between C, P1, P2, and P3 in both at baseline and post-treatment. However, there were significant increases in ALT levels after treatment in comparison to baseline in the control group (C) (87.2 ± 18.43 vs. 40.6 ± 5.02; p &lt; 0.05), P1 (78.9 ± 8.52 vs. 44.4 ± 1.14; p &lt; 0.05), and P3 (86.4 ± 17.22 vs. 44.0 ± 1.00; p &lt; 0.05). There were no differences in AST levels between C, P1, P2, and P3 at baseline, but there were significantly higher AST levels in P1, P2, and P3 in comparison to control at post-treatment (p &lt; 0.05). There were no differences in AST levels between P1, P2, and P3 at post-treatment (p &gt; 0.05). There were also significant increases in AST levels after treatment in comparison to baseline in the control group (C) (93.9 ± 1.10 vs. 37.7 ± 1.69; p &lt; 0.05), P1 (97.6 ± 1.85 vs. 36.3 ± 1.22; p &lt; 0.05), P2 (97.6 ± 1.70 vs. 37.7 ± 1.73; p &lt; 0.05), and P3 (98.6 ± 0.79 vs. 36.4 ± 1.20; p &lt; 0.05). CONCLUSION: The combination therapy of paracetamol and codeine might not bring difference in serum ALT and AST levels compared to paracetamol therapy alone or codeine therapy alone.

Effect of regular exercise on the levels of subfatin and asprosin: a trial with different types of exercise.

Subfatin (Metrnl) and asprosin are associated with metabolic diseases, such as obesity and diabetes. Exercise is among the most important regulators of health in humans and has been previously demonstrated to regulate these parameters. The present study aimed to investigate the effects of different types of regular exercises on levels of subfatin, asprosin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid, and glucose. The study included 120 young and healthy males, who participated in the study voluntarily. These participants were randomly divided into four groups, such as control (C), aerobic exercise (AE), intermittent (HIIT), and resistance exercise (RE) groups. Additionally, all the groups had equal numbers of participants. First, the subjects in the exercise group were made familiar with the exercise regime for two weeks. Then, they performed regular exercises, three days a week for eight weeks. Blood samples were collected from the participants at the beginning and end of the study. Subfatin and asprosin levels were analyzed using the ELISA method. AST, ALT, uric acid, and glucose levels were analyzed using the AutoAnalyzer. No differences were observed in pretest values between the groups (p>0.05). Assessment of intragroup changes demonstrated no significant changes in the control group. In the comparisons, statistically significant changes were recorded in the levels of subfatin, asprosin, and glucose in all exercise groups. Particularly, differences were observed in the levels of AST and uric acid in the AE and HIIT groups while differences in ALT levels were observed only in the AE group (p<0.05). In the conclusion of the study, different types of exercises caused significant changes in subfatin and asprosin levels. Thus, these results suggested that the parameters associated with metabolic diseases could be controlled with the aid of regular exercises.

S1118 Gender Disparities of Liver Injury at Presentation in COVID-19 Patients

INTRODUCTION: There are several reports suggesting abnormal liver enzymes occur in as many as 50% of patients infected by the novel coronavirus-19 (COVID-19). The purpose of our study was to examine the gender disparities in the prevalence of abnormal liver enzymes at initial presentation in COVID-19 patients. METHODS: We reviewed the charts of 11,265 adult patients with confirmed COVID-19 infection admitted to any of the 12 hospitals in our health system from March 1 to April 30, 2020. COVID-19 status was confirmed by polymerase chain reaction of a nasopharyngeal swab specimen. Labs drawn within 24 hours of presentation were considered baseline. Patients that had an age less than 18 or missing baseline data were excluded. Abnormalities in liver chemistries for AST (Aspartate Amino Transferase) and ALT (Alanine Amino Transferase) were grouped as follows: (1) within normal limits; (2) mild: greater than the upper limit of normal (ULN) to less than or equal to 4 times the ULN; (3) moderate: greater than 4 times the ULN to less than or equal to 10 times the ULN; and (4) severe: greater than 10 times the ULN. RESULTS: After exclusions, 10,856 patients were included in our study. There was a significant difference of the prevalence of liver injury between men and women (Table 1). Liver injury was present in 61% male and 40% female (P < 0.001). On univariate analysis, men (OR: 1.77 [95% CI: 1.64–1.92] and OR: 2.56 [95% CI: 2.06–3.17]) were more likely to have mild or moderate increases in AST but the difference was not apparent with ALT levels. These results were confirmed using the adjusted analysis after adjusting for baseline demographics and comorbidities (Table 2). CONCLUSION: Males presenting with COVID-19 infection are more likely to have elevated AST levels than females. There were no significant differences in ALT levels based upon gender. Elevated AST levels have been associated with a poor prognosis in hospitalized COVID-19 patients. Further research is needed to understand the mechanism of these gender-based differences in liver enzyme elevations, and their relationship to outcomes in COVID-19 infected patients.Table 1.: Frequencies of liver injuries in patients admitted with COVID-19 infectionTable 2.: Multinomial Logistic Regression Analysis showing the relative risk of Liver injury in Male patients With COVID-19 Compared to Female patients

Observation on clinical effects of recombinant human growth hormone on the treatment of children with severe burn

Objective: To observe the clinical effects of recombinant human growth hormone (rhGH) on children with severe burn. Methods: Clinical data of 94 children with severe burn, hospitalized in our burn unit from April 2012 to December 2016, conforming to the study criteria, were retrospectively analyzed. According to the use of rhGH, children were divided into rhGH group (n=50) and control group (n=44). Children in control group received conventional treatment, while children in rhGH group received both conventional and rhGH treatment. The rhGH treatment was started 3 to 5 days post injury in dosage of 0.2-0.4 U·kg(-1)·d(-1,) by way of subcutaneous injection, and the course of treatment was (11±5) d. The plasma albumin and prealbumin levels, heart rate, alanine aminotransferase (ALT), and serum creatinine level in 2 weeks post injury, times of skin grafting operation, hospitalization time, total hospitalization treatment cost, and sepsis and death of children were compared between the 2 groups. Data were processed with independent sample t test, Mann-Whitney U test, and Fisher's exact test. Results: (1) In 2 weeks post injury, the plasma albumin level [(36±4) g/L] and prealbumin level [(94±34) g/L] of children in rhGH group were significantly higher than those in control group [(33±4) and (73±20) g/L, t=3.666, 3.401, P<0.05]. (2) In 2 weeks post injury, the heart rate of children in rhGH group was (123±11) times per minute, which was slower than (130±14) times per minute of children in control group (t=2.839, P<0.05). There was no significant difference in ALT level of children between the 2 groups (Z=0.868, P>0.05). The blood creatinine levels of children in the 2 groups were within normal range. (3) The times of skin grafting operation of children in rhGH group was 0.3±0.5, which was significantly less than 0.5±0.6 in control group (Z=2.234, P<0.05). The hospitalization time of children in rhGH group was (22±8) days, which was shorter than (28±10) days in control group (t=2.837, P<0.05). The total hospitalization treatment cost of children in rhGH group was (41±15) thousand yuan, which was significantly less than (53±25) thousand yuan in control group (t=2.878, P<0.05). (4) There were 2 cases of sepsis in control group and 1 case of sepsis in rhGH group, with no significant difference between the 2 groups (P>0.05). No children died in the 2 groups. Conclusions: rhGH treatment of children with severe burn can correct post-injury hypoproteinemia, improve cardiac function, reduce the times of skin grafting operation and hospitalization treatment cost, shorten hospitalization time, with no significant effect on kidney and liver function, sepsis, and death.

The relationship between urinary genistein levels and serum alanine aminotransferase levels in adults in the USA: National Health and Nutrition Examination Survey 1999–2010

Genistein, a phytoestrogen with similarities to female sex hormones, has been shown to protect against oxidative stress and fibrosis in nonalcoholic fatty liver injury in animal studies. However, few studies have examined genistein's effects on liver function in humans. We analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2010. Individuals younger than 21 years, with viral hepatitis, or with serum alanine aminotransferase (ALT) at the extremes of distribution (5% on each extreme) were excluded. Urinary genistein was normalized by urinary creatinine levels. The relationship between normalized urinary genistein (nUG) and serum ALT was examined using linear regression models with and without adjustment for potential confounders, and the differential effect of sex was examined using an interaction term. Of the 9864 participants, 52% were female, 50% were White, 24% were elderly, 36% had hypertension, 12% had diabetes, and 8.1% were heavy alcohol drinkers. Serum ALT was significantly lower in the highest quartile compared with the lowest quartile of nUG (22.3 vs. 23.5 U/l; P<0.001). In adjusted models, individuals in the highest quartile had 0.75 U/l lower ALT levels than those in the lowest quartile (P=0.02). We found a significant difference in ALT levels between the lowest and highest quartiles of nUG in males, but not in females (difference in differences=1.77 U/l, interaction P=0.04). We found a statistically significant association between higher nUG and lower serum ALT in males, but not in females. The sex-specific role of genistein in mitigating liver disease merits further study.

Evaluation of Racial Differences and Association of Obesity on Elevated ALT Level: 10-Year Analysis of the National Health and Nutrition Examination Survey (NHANES)

Introduction: Obesity is a risk factor for non-alcoholic fatty liver disease (NAFLD) and it has important public health impact. Racial differences in alanine aminotransferase (ALT) levels have not been well described. This study aimed to identify racial differences on abnormal ALT levels in patients without liver disease and evaluate the association between obesity and elevated ALT levels in adults without other metabolic risk factors. Methods: The National Health and Nutrition Examination Survey was used to compare ALT levels by race and gender. Logistic regression models were constructed to evaluate the impact of obesity on elevated ALT and to identify potential risk factors for abnormal ALT levels. Obesity was classified according to BMI with WHO classification. Serum ALT levels were considered abnormal if >47 mg/dL in males and >35 mg/dL in females. We constructed multivariable logistic regression models using STATA software version 13. Results: We analyzed 9,025 patients. 2,347 patients (26%) were obese or morbidly obese, 2,099 patients (23%) were overweight, 2,772 had normal weight (31%) and 1,807 patients had BMI below the normal range (20%). No significant difference in ALT levels across overall races was found, however on the Hispanic subgroup analysis we found significant differences between Mexican when compared to Other Hispanics (Latinos from Central America and South America); (aOR 1.76, p < 0.01; CI: 1.3-2.1). Whites were not associated with high ALT levels and African Americans were the most unlikely to have high ALT levels (aOR 0.30, p < 0.01; CI: 0.20-0.44). Obesity was not significantly associated with elevated ALT (aOR 1.05, p < 0.7; CI: 0.7-1.5). However, Waist circumference was (aOR 1.04, p < 0.01; CI: 1.02-1.4). Female gender was protective against high ALT level (aOR 0.31, p < 0.01; CI: 0.24-0.40). Conclusion: Limitations: Retrospective study. Strength: Nationwide patient cohort. Incomplete comorbidity adjustment. Conclusion: Racial differences in ALT levels among adults are plausible. Mexican ethnicity but not Hispanic overall were significantly associated with higher levels of ALT. Abdominal obesity but not Overall obesity, in the absence of metabolic risk factors and other causes of liver disease, is associated with elevated ALT, providing evidence that abdominal lipotoxicity has may do more harm. These findings have important epidemiologic implications and need more investigations as it is a possible target for new screening interventions.

An assessment of racial differences in the upper limits of normal ALT levels in children and the effect of obesity on elevated values.

Childhood obesity is a risk factor for non-alcoholic fatty liver disease and poses important public health issues for children. Racial differences in alanine aminotransferase (ALT) levels among children have not been described. This study aimed to identify racial differences in upper limit normal (ULN) ALT levels and evaluate the effect of obesity on elevated levels in children without other metabolic risk factors. National Health and Nutrition Examination Surveys and clinical data from the Loyola University Health System were used to determine ULN ALT by race and gender. Quantile regression was used to evaluate the impact of obesity on elevated ALT and to identify potential risk factors for ALT above the ULN. Upper limit normal (ULN) ALT was approximately 28.0 and 21.0-24.0 U/L for boys and girls, respectively. No significant difference in ULN ALT across race was observed. Obesity was significantly associated with elevated ALT; obese children with elevated ALT had values 10 U/L higher than normal-weight children. Racial differences in ALT levels among adults are not evident in children. Obesity, in the absence of metabolic risk factors and other causes of liver disease, is associated with elevated ALT, providing evidence against the concept of healthy obesity in children.

Effect of Remote Preconditioning on Mild or Severe Ischemia–Reperfusion Injury to Rat Liver

In this study we examined the effect of remote ischemic preconditioning (RIPC) on liver ischemia–reperfusion (IR) injury. Anesthetized Wistar rats (200 to 250 g body weight, n = 32) had the right femoral artery (FA) dissected. Protocol I. The hepatic artery (HA) was clamped for 60 minutes; peripheral liver blood flow (PLBF) and alanine aminotransferase (ALT) were measured prior to clamping as well as 60 minutes after reperfusion. The cohorts were group 1 (no RIPC; n = 10) and group 2 (RIPC; n = 10) 35 minutes after surgery, the FA was clamped for 10 minutes. After 15 minutes, the HA was clamped as in group 1. In protocol II, a rubber band was applied around the entire vascular supply to about 70% of the liver, yielding group 3 (no RIPC; n = 6) that 60 minutes after surgery, had vascular occlusion performed for 30 minutes and group 4 (RIPC; n = 6) with the FA clamped as above, in a procedure otherwise identical to that of group 3. Results In protocol I, there was no significant difference in PLBF between the two groups after reperfusion, but the increased ALT levels in the RIPC group were reduced (.70 ± .05 vs. 1.0 ± .15 μkat/L, P = .049). In protocol II, we observed no significant differences in ALT levels or PLBF between the two groups. Thus, a beneficial effect of RIPC was demonstrated in protocol I with relative hypoxemia to the liver. However, the effect could not be demonstrated in protocol II, which induced a more severe IR injury.

Prevalence of hepatitis G virus RNA in a monocentric population of French haemophiliacs.

Hepatitis G virus (HGV) and hepatitis GB virus (GBV-C) have been reported as possible causes of non-A-E transfusional hepatitis. To assess the prevalence of hepatitis G virus infection in haemophiliacs we retrospectively investigated the presence of viral RNA in 92 patients with and without HCV infection. HGV/GBV-C RNA was reverse transcribed and amplified with primers from the 5' non-coding region of the genome. RNA was detected in 16/92 patients (17.4%). Restriction enzyme analysis revealed that the 16 patients belonged to the HGV-like genotype. Serology with E2-specific antibodies demonstrated that HGV viraemia underestimates previous infection by HGV. 33 patients were positive for HGV; all but two have cleared HGV RNA. 47/92 patients had a marker of prior infection by HGV. No difference between HGV RNA positive and negative patients was observed concerning age, diagnosis, HIV and HCV status. Previous HBV infection correlated with the frequency of HGV infection. There was no difference in alanine aminotransferase levels between HGV positive and negative patients. All 18 patients exposed to only virally inactivated plasma-derived concentrates were negative for both HGV RNA and anti E2 antibodies. Prior exposure to untreated concentrates correlated with HGV viraemia (P=0.03), HGV seropositivity (P=0.0002), and markers of HGV infection (P<0.0001). In haemophiliacs with a past exposure to non-inactivated concentrates, persistence of HCV RNA (53/74 patients) was more frequent than HGV RNA persistence (16/74 patients) although HGV viraemia is more frequent than HCV viraemia in blood donors. This may be related to a greater ability of individuals to clear HGV infection and suggests that hepatitis G virus infection in multi-transfused patients has a better outcome than infection with other blood-borne viruses.

Are Gender-Specific ALT Cutoff Values Necessary?

We examined the importance of using genderspecific alanine aminotransferase (ALT) cutoff values for screening blood donors for hepatitis C. Currently, a single cutoff value is recommended, regardless of donor gender. This study of 1,426 healthy blood donors demonstrated that ALT levels appear to be gender dependent; males have higher ALT levels than females. Differences in ALT levels between males and females are not explained adequately by hepatitis BorC infection. Use of gender-specific ALT cutoff values might result in a greater detection of infectious units among female donors, which in turn might lead to fewer transfusion-related hepatitis C infections. We recommend that only ALT data from donors who test negative for anti-hepatitis C virus, anti-hepatitis B surface antigen, and anti-hepatitis B core antigen should be used to determine ALT cutoff levels.

Higher Serum Alanine Aminotransferase Levels Among Hispanics in a Reference Population

The serum levels of many analytes have been shown to vary with the gender and racial background of the tested subjects. However, it is unclear whether serum alanine aminotransferase (ALT) levels exhibit similar heterogeneity. To investigate the effect of gender and racial / ethnic background on serum ALT activity, we compared the serum ALT levels of 1,069 healthy hospital employees; 349 whites, 433 blacks, and 287 Hispanics. Hispanics, both men and women, had significantly higher ALT levels than their white (P <.001) and black (P <.01) counterparts. Blacks had levels intermediate between those of whites and Hispanics. The difference in serum ALT activity between blacks and whites was significant only among men. Men in all three groups had higher (P <.001) ALT levels than women. We conclude that there are significant racial and sex differences in ALT levels among healthy hospital employees and that these differences should be taken into consideration when interpreting serum ALT results.