How far liver enzymes reflect the inflammatory activity in the liver of patients with chronic hepatitis C virus infection?

ABSTRACT

This study was performed to evaluate the utility of the AST/ALT ratio in patients with proven chronic hepatitis C virus infection and to distinguish patients with and without cirrhosis and to correlate the ratio with the other biochemical and histological features. This study was conducted on 51 patients with chronic hepatitis C virus, 30 of them without cirrhosis and 21 with cirrhosis according to liver biopsy. The patients were attendants of inpatients Medicine department, Liver Institute, Menoufia University. 20 healthy individual were serving as control group. They were subjected to complete clinical examination, complete liver function tests [ALT, AST, T and D- bilirubin, Albumin, ALP, GGT, PT] and platelet count. All serum samples of the patients were +ve for circulating HCV-RNA. Liver biopsy was performed to all patients to diagnose cirrhosis and histological activity index [HAI]. The AST/ALT ratio [1 was seen in 80% of cirrhotic patients and 0% of the noncirrhotic patients. Correlation of the AST/ALT ratio with the grades of HAI shows significant positive correlation with grade III [r =+0.40 p <0.01] and grade IV [r =+ 0.61 p <0.001]. While nonsignificant correlation with grade I and II [r = +0.14 p>0.05 and r =+ 0.23 p> 0.05 respectively] correlation of the platelets count with HAI show significant negative correlation with grade IV only [r = - 0.35 p< 0.01]. The 3 parameters of modified CDS score [platelets count, ALT/AST ratio, PT score] are compared in cirrhotic versus noncirrhotic patients, there were significant increase in the score of the 3 parameters and the total CDS score in cirrhotic than noncirrhotic patients. A total CDS score [8 was seen in 47.6% of cirrhotic patients and in 3.3% of noncirrhotic patients. CDS score [8 showing 96.6% specificity with positive predictive value in distinguishing patients with cirrhosis from patients without. In conclusion: AST/ALT >1 or total CDS score [8 may be useful for identifying patients of chronic HCV with cirrhosis. While patients with AST/ALT <1 or total CDS score < 7 still require histological examination of liver to identify cirrhosis