The Annals of Hepatology has published a groundbreaking study led by Dr. Jeremy J. Lee from the University of Dundee, which could change the way primary care physicians diagnose metabolic dysfunction-associated steatotic liver disease (MASLD), particularly in cases that involve advanced fibrosis. Traditionally, the upper limit of normal (ULN) for serum alanine aminotransferase (ALT) has been <55 U/L, but this new research proposes that lowering this threshold could significantly improve early detection rates.
DOI: 10.1016/j.aohep.2023.101280
In the study, “Optimal ALT threshold for the automated diagnosis of MASLD: A population-based study using iLFT,” published on January 14, 2024, in the Annals of Hepatology (Ann Hepatol 2024;29(2):101280), researchers conducted a comprehensive analysis using intelligent liver function testing (iLFT) to identify patients with MASLD. The study included 16,373 patients who underwent iLFT from March 2016 to April 2022, offering a substantial sample size for robust conclusions.
Out of the total participants, 762 (5%) exhibited MASLD with abnormal fibrosis scores, while 908 (6%) had MASLD but displayed normal fibrosis scores. Impressively, the application of iLFT revealed that a considerable fraction of patients with advanced fibrosis or cirrhosis had ALT levels between 31-54 U/L, a range that would typically not trigger further investigations under standard practice.
The findings underscored that 33% of MASLD patients with advanced fibrosis or cirrhosis had ALT levels below the traditional threshold, which means they could remain undiagnosed using conventional criteria. Through the examination of the implications of ALT cut-offs within the ranges of 31-41 U/L and 42-54 U/L, the study presented compelling evidence for the modification of current diagnostic protocols.
Dr. Lee and his team emphasized the need for adopting a lower ALT cut-off (>30 U/L) to ensure that more patients at risk of severe liver complications are accurately identified and provided the necessary medical attention. This innovative approach could pave the way for more efficient and timely treatment of MASLD patients, potentially reducing the risk of complications and mortality associated with the disease.
The Annals of Hepatology article also accounted for conflicts of interest, stating that while some authors declared none, others reported consultancy roles and educational grants from pharmaceutical companies, ensuring transparency in the study’s disclosures.
References
1. Lee, J. J., Byrne, C. J., Brennan, P. N., MacPherson, I., Dow, E., & Dillon, J. F. (2024). Optimal ALT threshold for the automated diagnosis of MASLD: A population-based study using iLFT. Annals of Hepatology, 29(2), 101280. https://doi.org/10.1016/j.aohep.2023.101280
2. National Institutes of Health. (n.d.). Liver Diseases. Retrieved January 20, 2024, from https://www.niddk.nih.gov/health-information/liver-disease
3. Mayo Clinic. (n.d.). Elevated liver enzymes. Retrieved January 22, 2024, from https://www.mayoclinic.org/diseases-conditions/elevated-liver-enzymes
4. MedlinePlus. (n.d.). Liver Function Tests. Retrieved January 23, 2024, from https://medlineplus.gov/lab-tests/liver-function-tests/
5. European Association for the Study of the Liver. (2022). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 76(1), 1-42. https://doi.org/10.1016/j.jhep.2021.11.015
Keywords
1. ALT threshold MASLD
2. Advanced fibrosis diagnosis
3. Liver function testing
4. Metabolic liver disease detection
5. Primary care liver diagnostics
This study not only sheds light on a critical area of diagnostic enhancement but underscores the importance of continuous research in optimizing medical protocols for better patient outcomes. By adopting a lower ALT threshold as suggested by the study, healthcare providers can take an important step toward the goal of preemptively treating MASLD, ultimately benefiting a population that may otherwise go undiagnosed until it is too late.