AST/ALT Ratio Predicts Cirrhosis in Patients With Chronic Hepatitis C Virus Infection

TLDR

Liver biopsy is required to stage chronic HCV infection, and prior work in nonalcoholic liver disease has shown that an AST/ALT ratio >1 can indicate cirrhosis. The study aimed to evaluate whether the AST/ALT ratio can differentiate cirrhotic from noncirrhotic chronic HCV patients and to assess its correlation with histologic grade, fibrosis stage, and other biochemical markers. The authors retrospectively analyzed 139 chronic HCV patients, measuring routine biochemical indices and scoring liver biopsy specimens for necroinflammatory activity and fibrosis stage. Patients with cirrhosis had a significantly higher mean AST/ALT ratio (1.06 vs 0.60), and a ratio ≥1 yielded 100 % specificity and PPV, 53.2 % sensitivity, and 80.7 % NPV for cirrhosis, correlating positively with fibrosis stage but not activity grade or other markers, and 17 % of cirrhotic patients were identified solely by this ratio.

Abstract

Objective: A liver biopsy is necessary to grade and stage chronic hepatitis C virus (HCV) infection. In a previous study of patients with nonalcoholic liver disease, an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio > 1 suggested cirrhosis. We sought to examine the value of the AST/ALT ratio in distinguishing cirrhotic patients with chronic HCV infection from noncirrhotic patients and to correlate the ratio with the grade and stage of hepatitis and other biochemical indices. Methods: We retrospectively studied 139 patients with chronic HCV infection. Routine biochemical indices were determined, and the histological grade of necroinflammatory activity and the stage of fibrosis of the liver biopsy specimens were scored. Results: The mean AST/ALT ratio in the cirrhotic patients (n = 47) was higher than in the noncirrhotic patients (n = 92) (1.06 ± 0.06 vs 0.60 ± 0.09; p < 0.001). A ratio ≥1 had 100% specificity and positive predictive value in distinguishing cirrhotic from noncirrhotic patients, with a 53.2% sensitivity and 80.7% negative predictive value. The ratio correlated positively with the stage of fibrosis but not with the grade of activity or other biochemical indices. Of the cirrhotic patients, 17% had no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio ≥1. Conclusion: The AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection.