Nephrology Dialysis Transplantation, Vol 12, Issue 1 180-183, Copyright © 1997 by Oxford University Press
K Hung, K Lee, C Yen, K Wu, T Tsai and W Chen
Background. To determine the best cutoff values of
aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in
detecting viral hepatitis C infection among patients of continuous
ambulatory peritoneal dialysis (CAPD). Methods. 90 (44
male and 46 female) CAPD patients and 526 adult controls (266 male, 260
female) were enrolled. Serum AST and ALT were measured by an auto-analyser
monthly. Serum HBsAg was examined Using a RIA method and anti-HCV by an
second-generation EIA method. The best cutoff values of AST and ALT for
detecting viral hepatitis were obtained from the ROC (receiver-operating
characteristic) curve. Results. The prevalence of
anti-HCV(+) was significantly higher in CAPD patients (16.7%) than in
normal contrOls (4.9%), while that of HBsAg(+) was similar in both groups.
CAPD patients had significantly lower levels of serum aminotransferases
compared to normal controls. Mean AST were 23.8 IU/l in normal control and
18.8 IU/l in the CAPD patients (P <0.001). Mean ALT were 21.9 IU/l
in normal controls and 15.3 IU/l in the CAPD patients (P <0.001).
CAPD patients with HCV infection had higher serum AST and ALT levels than
those without. However, HBV infection did not cause significant serum
aminotransferase elevation in patients. The conventional cutoff values of
AST (40 IU/l) and ALT (40 IU/l) for detecting viral hepatitis yielded only
a sensitivity of 27.3 and 18.2% respectively; on the contrary, our revised
cutoff values of AST (24 IU/l) and ALT (17 IU/l) had better sensitivities
(AST, 72.7%; ALT 63.6%). For serial aminotransferase values, the
sensitivity of AST and ALT for detecting HCV were 36.4 and 27.3% by
conventional criteria, and were both 81.8%, by our newly revised criteria.
Conclusions. Serum aminotransferase cutoff values
should be modified for screening viral hepatitis in a CAPD population. Our
new cutoff criteria had important clinical implications in providing
benefits of earlier detection and possible prevention from chronic hepatic
deteriorations. Keywords: serum aminotransferase;
viral hepatitis; CAPD
ORIGINAL ARTICLES
Revised cutoff values of serum aminotransferase in detecting viral hepatitis among CAPD patients: experience from Taiwan, an endemic area for hepatitis B
Departments of Internal Medicine, National Taiwan University Hospital, No 7 Chung-Shan South Road, Taipei, Taiwan; Provincial Chang-Hua Hospital, Taiwan; Corresponding author
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