Chronic Hepatitis B: Serum ALT Cutoff Value Predictive of Liver-Related Mortality

liver function test
liver function test
A study sought to determine the optimal cutoff for serum ALT that may be predictive of liver-related mortality in patients with chronic hepatitis B infection.

In patients with chronic hepatitis B, serum alanine aminotransferase (ALT) levels are positively correlated with liver-related mortality, according to study results published in Liver International.

The researchers recommend that patients age >40 with serum ALT levels above the upper limit of normal should be carefully monitored or started on antiviral therapy earlier.

The study included participants enrolled in the Health Examination Cohort of the National Health Insurance Service of Korea age 40 to 79 with  chronic hepatitis B and no other concurrent liver disease (n=12,486). The researchers investigated liver-related mortality — including death from liver cancer — for 9 years.

The study researchers found a positive correlation between serum ALT levels and liver-related mortality in both men and women. The liver-related mortality rates in men were 0.14, 0.17, 0.24, 0.57, 0.63, and 0.85 per 100 person-years for serum ALT levels of <20, 20-29, 30-39, 40-49, 50-79, and ≥80 U/L, respectively. The liver-related mortality rates in women were 0.03, 0.09, 0.12, 0.63, 0.65, and 0.32 per 100 person-years for serum ALT levels of <20, 20-29, 30-39, 40-49, 50-79 and ≥80 U/L, respectively.

In patients with ALT of 40-79 U/L, the liver-related mortality rates were 0.60 per 100 person-years in men and 0.64 per 100 person-years in women. These were similar to the overall mortality rate of age- and sex-matched subjects without chronic hepatitis B (0.69 per 100 person-years).

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The researchers determined that the best cutoff values for liver-related mortality prediction were >34 U/L in men (P <.0001) and >30 U/L in women (P <.0001).

“This study showed [the] clinical utility of serum ALT level for prediction of the long-term prognoses of patients with CHB,” the researchers wrote.


Shim J, Kim JW, Oh CH, et al. Serum alanine aminotransferase level and liver-related mortality in patients with chronic hepatitis B: a large national cohort study [published online January 27, 2018] Liver Int. doi:10.1111/liv.13705