Forlano R, Mullish BH, Dhar A, Goldin RD, Thursz M, Manousou P. Liver function tests and metabolic-associated fatty liver disease: Changes in upper normal limits, does it really matter? World J Hepatol 2021; 13(12): 2104-2112 [PMID: 35070011 DOI: 10.4254/wjh.v13.i12.2104]
Corresponding Author of This Article
Pinelopi Manousou, MD, PhD, Senior Lecturer, Liver Unit/Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Exhibition Road, London W2 1NY, United Kingdom. p.manousou@imperial.ac.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2021; 13(12): 2104-2112 Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2104
Liver function tests and metabolic-associated fatty liver disease: Changes in upper normal limits, does it really matter?
Roberta Forlano, Benjamin H Mullish, Ameet Dhar, Robert D Goldin, Mark Thursz, Pinelopi Manousou
Roberta Forlano, Benjamin H Mullish, Ameet Dhar, Mark Thursz, Pinelopi Manousou, Liver Unit/Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London W2 1NY, United Kingdom
Robert D Goldin, Centre for Pathology, Department of Medicine, Imperial College London, London W2 1NY, United Kingdom
Author contributions: Forlano R performed the research and wrote the paper; Mullish BH, Dhar A, Goldin RD, Thursz MR provided clinical advice and contributed to the draft; Manousou P designed the research and supervised the report.
Supported byNational Institute of Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London; NIHR Academic Clinical Lectureship, No. CL-2019-21-002; European Association for The Study of the Liver, PhD fellowship Juan Rodes 2018.
Institutional review board statement: This study was considered a service evaluation project, using routinely collected patient data, therefore no ethical approval was required under the UK policy framework for health and social care.
Informed consent statement: The Informed consent is not required.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pinelopi Manousou, MD, PhD, Senior Lecturer, Liver Unit/Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Exhibition Road, London W2 1NY, United Kingdom. p.manousou@imperial.ac.uk
Received: April 21, 2021 Peer-review started: April 21, 2021 First decision: June 23, 2021 Revised: July 2, 2021 Accepted: November 15, 2021 Article in press: November 15, 2021 Published online: December 27, 2021 Processing time: 249 Days and 20 Hours
ARTICLE HIGHLIGHTS
Research background
Elevated liver function tests (LFTs) often represent the main reason for referring patients with metabolic-associated fatty liver disease (MAFLD) to secondary and tertiary care.
Research motivation
In MAFLD, liver function tests may both under and over-estimate liver disease. Moreover, difference in upper normal limit (UNL) of LFTs is consistent across the literature.
Research objectives
As such, we investigated the potential use of different UNLs of LFTs in MAFLD.
Research methods
We evaluated the use of a lower UNL of ALT vs histology and liver stiffness measurement in a cohort of 436 patients with non-alcoholic fatty liver disease in a tertiary care centre.
Research results
Modifying the upper normal limit of LFTs does not improve the diagnostic performance of the test in MAFLD.
Research conclusions
In MAFLD, the risk-stratification should rely on a combination of risk factors and non-invasive markers, rather than on LFTs alone.
Research perspectives
Future research should focus on identifying biomarkers for diagnosing metabolic-associated steato-hepatitis and advanced fibrosis.
