Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects

W. C. Wu, C. Y. Wu, Y. J. Wang, H. H. Hung, H. I. Yang, W. Y. Kao, C. W. Su, J. C. Wu, W. L. Chan, H. C. Lin, F. Y. Lee, S. D. Lee

研究成果: 雜誌貢獻文章

34 引文 (Scopus)

摘要

Background: The sensitivity of current upper limit of normal (ULN) of serum alanine aminotransferase (ALT) levels for detecting chronic liver disease has been challenged recently. Aim: To identify modulating factors for serum ALT levels and to refine its ULN threshold. Methods: We enrolled 34 346 consecutive subjects who completed the health check-up at Taipei Veterans General Hospital from 2002 to 2009. ULN was set for healthy ALT level to the 95th percentile of the reference healthy population. Results: A group of 21 282 subjects were used as a training set to define an ULN with the highest sensitivity; afterwards, this ULN was validated in another set of 13 064 subjects. A reference healthy population was selected from the training set after excluding subjects with any abnormalities in independent risk factors associated with elevated serum ALT level (>40 IU/L) by multivariate analysis like body mass index, waist circumference, glucose, cholesterol, high-density lipoprotein-cholesterol, triglyceride, hepatitis B virus surface antigen, anti-hepatitis C virus antibody and fatty liver. The new ULN of serum ALT level defined as the 95% percentile in the healthy population were 21 IU/L and 17 IU/L for men and women respectively. These cut-off values had the highest Youden's index and areas under the corresponding receiver operating curves among four widely applied thresholds in both the training and validation sets. Conclusions: The suggested threshold of upper limit of normal provides better discrimination between healthy and unhealthy status. Viral hepatitis, metabolic syndrome and fatty liver are the major risk factors of elevated serum alanine aminotransferase levels.

原文英語
頁(從 - 到)560-568
頁數9
期刊Alimentary Pharmacology and Therapeutics
36
發行號6
DOIs
出版狀態已發佈 - 九月 1 2012

指紋

Alanine Transaminase
Serum
Population
Fatty Liver
Veterans Hospitals
Hepatitis C Antibodies
Waist Circumference
Hepatitis B Surface Antigens
Hepatitis B virus
General Hospitals
HDL Cholesterol
Hepatitis
Liver Diseases
Triglycerides
Body Mass Index
Chronic Disease
Multivariate Analysis
Cholesterol
Glucose
Health

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

引用此文

Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects. / Wu, W. C.; Wu, C. Y.; Wang, Y. J.; Hung, H. H.; Yang, H. I.; Kao, W. Y.; Su, C. W.; Wu, J. C.; Chan, W. L.; Lin, H. C.; Lee, F. Y.; Lee, S. D.

於: Alimentary Pharmacology and Therapeutics, 卷 36, 編號 6, 01.09.2012, p. 560-568.

研究成果: 雜誌貢獻文章

Wu, W. C. ; Wu, C. Y. ; Wang, Y. J. ; Hung, H. H. ; Yang, H. I. ; Kao, W. Y. ; Su, C. W. ; Wu, J. C. ; Chan, W. L. ; Lin, H. C. ; Lee, F. Y. ; Lee, S. D. / Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects. 於: Alimentary Pharmacology and Therapeutics. 2012 ; 卷 36, 編號 6. 頁 560-568.
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abstract = "Background: The sensitivity of current upper limit of normal (ULN) of serum alanine aminotransferase (ALT) levels for detecting chronic liver disease has been challenged recently. Aim: To identify modulating factors for serum ALT levels and to refine its ULN threshold. Methods: We enrolled 34 346 consecutive subjects who completed the health check-up at Taipei Veterans General Hospital from 2002 to 2009. ULN was set for healthy ALT level to the 95th percentile of the reference healthy population. Results: A group of 21 282 subjects were used as a training set to define an ULN with the highest sensitivity; afterwards, this ULN was validated in another set of 13 064 subjects. A reference healthy population was selected from the training set after excluding subjects with any abnormalities in independent risk factors associated with elevated serum ALT level (>40 IU/L) by multivariate analysis like body mass index, waist circumference, glucose, cholesterol, high-density lipoprotein-cholesterol, triglyceride, hepatitis B virus surface antigen, anti-hepatitis C virus antibody and fatty liver. The new ULN of serum ALT level defined as the 95{\%} percentile in the healthy population were 21 IU/L and 17 IU/L for men and women respectively. These cut-off values had the highest Youden's index and areas under the corresponding receiver operating curves among four widely applied thresholds in both the training and validation sets. Conclusions: The suggested threshold of upper limit of normal provides better discrimination between healthy and unhealthy status. Viral hepatitis, metabolic syndrome and fatty liver are the major risk factors of elevated serum alanine aminotransferase levels.",
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AU - Wu, C. Y.

AU - Wang, Y. J.

AU - Hung, H. H.

AU - Yang, H. I.

AU - Kao, W. Y.

AU - Su, C. W.

AU - Wu, J. C.

AU - Chan, W. L.

AU - Lin, H. C.

AU - Lee, F. Y.

AU - Lee, S. D.

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N2 - Background: The sensitivity of current upper limit of normal (ULN) of serum alanine aminotransferase (ALT) levels for detecting chronic liver disease has been challenged recently. Aim: To identify modulating factors for serum ALT levels and to refine its ULN threshold. Methods: We enrolled 34 346 consecutive subjects who completed the health check-up at Taipei Veterans General Hospital from 2002 to 2009. ULN was set for healthy ALT level to the 95th percentile of the reference healthy population. Results: A group of 21 282 subjects were used as a training set to define an ULN with the highest sensitivity; afterwards, this ULN was validated in another set of 13 064 subjects. A reference healthy population was selected from the training set after excluding subjects with any abnormalities in independent risk factors associated with elevated serum ALT level (>40 IU/L) by multivariate analysis like body mass index, waist circumference, glucose, cholesterol, high-density lipoprotein-cholesterol, triglyceride, hepatitis B virus surface antigen, anti-hepatitis C virus antibody and fatty liver. The new ULN of serum ALT level defined as the 95% percentile in the healthy population were 21 IU/L and 17 IU/L for men and women respectively. These cut-off values had the highest Youden's index and areas under the corresponding receiver operating curves among four widely applied thresholds in both the training and validation sets. Conclusions: The suggested threshold of upper limit of normal provides better discrimination between healthy and unhealthy status. Viral hepatitis, metabolic syndrome and fatty liver are the major risk factors of elevated serum alanine aminotransferase levels.

AB - Background: The sensitivity of current upper limit of normal (ULN) of serum alanine aminotransferase (ALT) levels for detecting chronic liver disease has been challenged recently. Aim: To identify modulating factors for serum ALT levels and to refine its ULN threshold. Methods: We enrolled 34 346 consecutive subjects who completed the health check-up at Taipei Veterans General Hospital from 2002 to 2009. ULN was set for healthy ALT level to the 95th percentile of the reference healthy population. Results: A group of 21 282 subjects were used as a training set to define an ULN with the highest sensitivity; afterwards, this ULN was validated in another set of 13 064 subjects. A reference healthy population was selected from the training set after excluding subjects with any abnormalities in independent risk factors associated with elevated serum ALT level (>40 IU/L) by multivariate analysis like body mass index, waist circumference, glucose, cholesterol, high-density lipoprotein-cholesterol, triglyceride, hepatitis B virus surface antigen, anti-hepatitis C virus antibody and fatty liver. The new ULN of serum ALT level defined as the 95% percentile in the healthy population were 21 IU/L and 17 IU/L for men and women respectively. These cut-off values had the highest Youden's index and areas under the corresponding receiver operating curves among four widely applied thresholds in both the training and validation sets. Conclusions: The suggested threshold of upper limit of normal provides better discrimination between healthy and unhealthy status. Viral hepatitis, metabolic syndrome and fatty liver are the major risk factors of elevated serum alanine aminotransferase levels.

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