What is an ALT blood test. How does it assess liver damage. Why are ALT levels important for diagnosing liver conditions. When should you get an ALT test. What do elevated ALT levels indicate. How are ALT tests performed. What other tests complement ALT for liver health assessment.

What is ALT and Why is it Important for Liver Health?

Alanine aminotransferase (ALT) is an enzyme primarily found in liver cells. When liver cells are damaged or die, ALT is released into the bloodstream. Measuring ALT levels through a blood test can provide valuable insights into liver health and function.

ALT plays a crucial role in:

• Assessing liver damage
• Monitoring liver disease progression
• Evaluating the effectiveness of liver treatments
• Screening for potential liver problems

Understanding ALT levels is essential for both patients and healthcare providers in managing liver health effectively.

The ALT Blood Test: Purpose and Procedure

An ALT blood test is a simple and non-invasive procedure used to measure the levels of ALT in the bloodstream. This test is often part of a comprehensive liver function panel.

When is an ALT test recommended?

Healthcare providers may order an ALT test in various scenarios:

• As part of routine health screenings
• To investigate symptoms of liver disease
• To monitor known liver conditions
• To assess the impact of medications on liver function

The test procedure involves drawing a small blood sample from a vein, typically in the arm. Results are usually available within a few days.

Interpreting ALT Test Results: What Do the Numbers Mean?

ALT levels are measured in units per liter (U/L) of blood. Normal ranges can vary slightly depending on the laboratory and testing method used. However, general guidelines for ALT levels are:

• Men: 7 to 55 U/L
• Women: 7 to 45 U/L

Elevated ALT levels may indicate liver damage or disease. However, it’s important to note that ALT levels can fluctuate, and a single elevated result doesn’t necessarily indicate a severe problem.

What can cause elevated ALT levels?

Several factors can lead to increased ALT levels:

• Viral hepatitis (A, B, or C)
• Alcoholic liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Certain medications
• Obesity
• Autoimmune liver diseases

It’s crucial to interpret ALT results in conjunction with other liver function tests and clinical symptoms for a comprehensive assessment of liver health.

ALT and AST: The Dynamic Duo of Liver Enzymes

While ALT is specific to liver cells, aspartate aminotransferase (AST) is another enzyme often measured alongside ALT. AST is found in various tissues, including the liver, heart, and muscles.

How do ALT and AST levels compare in liver health assessment?

The ratio of AST to ALT can provide additional insights into liver health:

• In most liver diseases, ALT levels are higher than AST levels
• An AST/ALT ratio greater than 1 may suggest advanced liver disease or cirrhosis
• A ratio greater than 2 often indicates alcoholic liver disease

Healthcare providers use the AST/ALT ratio, along with other clinical information, to help diagnose and monitor liver conditions more accurately.

Beyond ALT: Comprehensive Liver Health Assessment

While ALT is a valuable marker of liver health, it’s often used in conjunction with other tests for a more comprehensive evaluation.

What other tests complement ALT in assessing liver function?

Additional tests that may be performed include:

1. Alkaline phosphatase (ALP)
2. Gamma-glutamyl transferase (GGT)
3. Bilirubin
4. Albumin
5. Prothrombin time (PT)

These tests, along with ALT and AST, provide a more complete picture of liver function and can help identify specific liver conditions.

Non-Invasive Alternatives: Fibroscan and Blood-Based Fibrosis Tests

While liver biopsy has traditionally been the gold standard for assessing liver damage, non-invasive techniques are gaining popularity due to their safety and convenience.

What is Fibroscan and how does it work?

Fibroscan is a non-invasive technique that uses sound waves to measure liver stiffness. It offers several advantages:

• Quick and painless procedure
• No need for tissue sampling
• Provides immediate results
• Can distinguish different stages of liver fibrosis and cirrhosis

Fibroscan results are measured on a scale of 0 to 75, with higher values indicating increased liver stiffness and potential fibrosis or cirrhosis.

What are blood-based fibrosis tests?

Several blood tests can be used as markers of liver damage, including:

• Fibrotest
• Fibrosure
• Actitest

These tests analyze various biomarkers in the blood to estimate the degree of liver fibrosis, offering a non-invasive alternative to liver biopsy in many cases.

Liver Biopsy: When is it Necessary?

Although non-invasive techniques are increasingly used, liver biopsy remains an important diagnostic tool in certain situations.

Why might a healthcare provider recommend a liver biopsy?

Liver biopsy may be necessary when:

• Non-invasive tests provide inconclusive results
• A more detailed assessment of liver tissue is required
• Specific liver diseases need to be diagnosed or staged accurately
• Monitoring the progression of known liver conditions

During a liver biopsy, a small sample of liver tissue is removed and examined under a microscope. This allows for direct assessment of liver inflammation, fibrosis, and other abnormalities.

How are liver biopsy results interpreted?

Several scoring systems are used to grade liver biopsies, including:

• Ishak HAI
• Metavir
• Knodell
• Child-Pugh (for cirrhosis)

These systems assess the degree of inflammation and fibrosis in the liver tissue, helping healthcare providers determine the stage of liver disease and guide treatment decisions.

Monitoring Liver Health: The Importance of Regular Testing

Regular monitoring of liver health through ALT tests and other assessments is crucial for early detection and management of liver conditions.

How often should liver function be tested?

The frequency of liver function testing depends on individual factors, including:

• Presence of known liver conditions
• Risk factors for liver disease
• Medications that may affect liver function
• Overall health status

For individuals with chronic liver conditions, more frequent monitoring may be necessary to track disease progression and adjust treatment plans accordingly.

What lifestyle factors can influence ALT levels?

Several lifestyle factors can impact ALT levels and overall liver health:

• Alcohol consumption
• Diet and nutrition
• Exercise habits
• Weight management
• Stress levels

Maintaining a healthy lifestyle can help keep ALT levels within normal ranges and support optimal liver function.

The Future of Liver Health Assessment: Emerging Technologies and Biomarkers

As medical research advances, new technologies and biomarkers are being developed to enhance liver health assessment.

What innovative approaches are being explored for liver health evaluation?

Emerging technologies and techniques include:

• Advanced imaging techniques (e.g., magnetic resonance elastography)
• Artificial intelligence-assisted analysis of liver imaging
• Novel blood-based biomarkers for liver fibrosis and inflammation
• Genetic testing for liver disease susceptibility

These advancements may lead to more accurate, non-invasive methods for assessing liver health and predicting disease progression.

How might personalized medicine impact liver health management?

The field of personalized medicine holds promise for tailoring liver health assessments and treatments to individual patients. This approach may involve:

• Analyzing genetic factors influencing liver disease risk and progression
• Developing targeted therapies based on specific liver disease mechanisms
• Customizing monitoring protocols based on individual risk profiles
• Integrating multiple biomarkers for more comprehensive liver health assessment

As research progresses, personalized approaches may lead to more effective prevention, diagnosis, and treatment of liver conditions.

Understanding Liver Fibrosis Progression: Implications for Patient Care

The rate of liver fibrosis progression varies among individuals with chronic liver diseases, such as hepatitis C. Understanding these differences is crucial for patient management and treatment planning.

How is liver fibrosis progression classified?

Research has identified three main categories of fibrosis progression:

1. Rapid fibrosers: May develop cirrhosis within 20 years of initial infection
2. Intermediate fibrosers: Expected to develop cirrhosis around 30 years after infection
3. Slow fibrosers: May take over 50 years to develop cirrhosis, if at all

These classifications help healthcare providers assess the urgency of treatment and the need for more frequent monitoring in patients with chronic liver conditions.

What factors influence the rate of liver fibrosis progression?

Several factors can affect how quickly liver fibrosis advances:

• Age at the time of infection
• Gender (men typically progress faster than women)
• Alcohol consumption
• Presence of other liver conditions (e.g., fatty liver disease)
• Immune system function
• Genetic factors

Understanding these factors can help healthcare providers develop personalized management strategies for patients with chronic liver diseases.

Liver Health Education: Empowering Patients and the Public

Promoting awareness and education about liver health is essential for early detection and prevention of liver diseases.

What key messages should be communicated about liver health?

Important points to emphasize in liver health education include:

• The liver’s vital role in overall health
• Common risk factors for liver disease
• Importance of regular health check-ups, including liver function tests
• Impact of lifestyle choices on liver health
• Early signs and symptoms of liver problems
• Available screening and diagnostic tools for liver health assessment

Effective education can empower individuals to take proactive steps in maintaining their liver health and seeking timely medical attention when needed.

How can healthcare providers improve liver health awareness?

Healthcare professionals can enhance liver health awareness through various strategies:

• Incorporating liver health discussions into routine check-ups
• Providing patient education materials on liver health and disease prevention
• Organizing community health fairs and screening events
• Collaborating with public health organizations to promote liver health initiatives
• Utilizing digital platforms and social media to share liver health information

By raising awareness and providing accessible information, healthcare providers can play a crucial role in improving liver health outcomes across populations.

Global Perspectives on Liver Health: Challenges and Opportunities

Liver health is a global concern, with varying challenges and approaches across different regions and healthcare systems.

What are the major global challenges in liver health management?

Key issues affecting liver health on a global scale include:

• Disparities in access to liver health screening and treatment
• Variability in healthcare resources and infrastructure
• Differences in prevalence of liver disease risk factors across populations
• Cultural and socioeconomic factors influencing liver health behaviors
• Emerging liver health threats, such as the increasing prevalence of NAFLD

Addressing these challenges requires coordinated efforts from healthcare providers, policymakers, and public health organizations worldwide.

What innovative approaches are being implemented globally to improve liver health?

Various initiatives are being developed to enhance liver health management globally:

• Telemedicine programs for remote liver health consultations
• Mobile health applications for liver disease risk assessment and monitoring
• Public-private partnerships to improve access to liver health technologies
• Global research collaborations to advance liver disease understanding and treatment
• Integration of liver health into primary care and public health programs

These innovative approaches aim to overcome geographical and resource barriers, making liver health assessment and management more accessible to diverse populations worldwide.

Assessment of liver damage | Hepatitis C Trust

Blood Tests

One way of assessing if liver cells are dying is by testing the level of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood. This is not particularly reliable as in most cases of chronic hepatitis C infection the liver function tests tend to fluctuate. Over the space of just a few days the results can vary from normal to noticeably raised. Raised ALT levels are present in around two-thirds of those infected while the remaining third show no evidence of elevated levels at all. These traditional liver function tests are not very effective indicators of liver damage in chronic hepatitis C. Currently the most reliable way to assess the extent of liver damage is by liver biopsy, however a fibroscan or other non-invasive techniques will be sufficient in most cases.

There are also blood tests that are used in the UK as markers of liver damage, such as Fibrotest, Fibrosure, and Actitest. Another way some doctors determine the presence of cirrhosis is by looking over time at the AST/ALT ratio. It seems that if the AST is consistently higher than ALT or equal to it, this is highly suggestive of cirrhosis.

Biopsy

At present the most accurate way to check the extent of liver damage is by biopsy. However, it is very unlikely to be used as there are other less invasive methods available. A liver biopsy is a test in which small pieces of liver tissue are removed and examined under a microscope. This is done via a long needle inserted usually between the 8th and 9th ribs under the right arm. The tissue will be assessed to see the extent of inflammation and fibrosis (as well as revealing other abnormalities such as damage to bile ducts and the presence of fat).

The degree of inflammation is described in terms of inflammatory grade. Fibrosis is described by fibrotic grade. There are several different scoring and grading systems for liver biopsies and the same numbers are not comparable with another system, all of which can seem confusing. The systems used in the UK are the Ishak HAI, the Metavir and the Knodell systems and the Child-Pugh grading system for cirrhosis. The biopsy will indicate which stage of inflammation and fibrosis (scarring) are present in the liver. Inflammatory grade will range from none to extensive inflammation. Fibrotic grade will range from minimal scarring, scarring that has developed outside of the portal tracts (see below), to fibrosis that has spread or is bridging towards neighbouring portal tracts to cirrhosis.

In hepatitis C active fibrosis begins around the portal areas in the liver. The portal areas are tiny tracts of connective tissue within the liver that contain branches of the portal vein (the main blood supply of the liver linking through the small intestine, stomach, pancreas and spleen).

As the fibrosis worsens, it may extend from one portal zone to the others which adjoin it. This is called bridging fibrosis. Bridging fibrosis is the stage before cirrhosis and ranges from early to marked bridging fibrosis. Cirrhosis is characterized by serious scarring that alters the liver’s structure and its ability to function.

The most extensive study of the rate of progression of fibrosis split people into three groups – ‘rapid fibrosers’, ‘intermediate fibrosers’ and ‘slow fibrosers’. The largest group in the study, just over a third, were intermediate fibrosers who would be expected to develop cirrhosis around thirty years after initial infection with HCV. Just over a third of patients were expected to develop cirrhosis in less than 20 years (rapid fibrosers), while just under a third would progress to cirrhosis in more than 50 years, if ever (slow fibrosers).

Fibroscan

Fibroscan is a non-invasive test using a sound wave to measure the elasticity of the liver and is being used more and more in the UK. As damage to the liver increases, so it becomes stiffer. The stiffer or less elastic the liver, the faster the sound wave travels. The Fibroscan has been shown to be accurate in measuring little or no damage and in measuring cirrhosis. It has been less accurate at distinguishing intermediate degrees of fibrosis.

The machine is calibrated from 0 to 75, with around 4 representing no liver damage, 4-12 increasing amounts of fibrosis, 12-15 the beginnings of cirrhosis.

Its advantage over a biopsy is that it is quick and completely painless. This is because the probe is simply placed against the skin and nothing is inserted into the body. It is also capable of distinguishing differing degrees of cirrhosis as 80% of its entire range measures cirrhosis. For example, a score of 30 indicates existing or imminent decompensation.

Alanine Aminotransferase (ALT) Test Test Information

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Test Overview

An alanine aminotransferase (ALT) test measures the amount of this enzyme in the blood. ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas. ALT was formerly called serum glutamic pyruvic transaminase (SGPT).

ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused by liver damage.

The ALT test is often done along with other tests that check for liver damage, including aspartate aminotransferase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), and bilirubin. Both ALT and AST levels are reliable tests for liver damage.

Why It Is Done

The ALT test is done to:

• Identify liver disease, such as cirrhosis and hepatitis, caused by alcohol, drugs, or viruses.
• Help check for liver damage.
• Find out whether jaundice was caused by a blood disorder or liver disease.
• Keep track of the effects of medicines that can damage the liver.

How To Prepare

Avoid strenuous exercise just before having an ALT test.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.

How long the test takes

The test will take a few minutes.

Watch

• Learning About Your Blood Test
• Learning About Blood Tests for Children

How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.

Results

Each lab has a different range for what’s normal. Your lab report should show the range that your lab uses for each test. The normal range is just a guide. Your doctor will also look at your results based on your age, health, and other factors. A value that isn’t in the normal range may still be normal for you.

Results are usually available within 12 hours.

High values

High levels of ALT may be caused by:

• Liver damage from conditions such as hepatitis or cirrhosis.
• Lead poisoning.
• Very strenuous exercise or severe injury to a muscle.
• Exposure to carbon tetrachloride.
• Decay of a large tumor (necrosis).
• Many medicines, such as statins, antibiotics, chemotherapy, aspirin, opioids, and barbiturates.
• Mononucleosis.
• Growth spurts, especially in young children. Rapid growth can cause mildly elevated levels of ALT.

Credits

Use of elastography in patients with chronic liver disease

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Use of elastography in patients with chronic liver disease

Authors: Zhuravleva L.V., Ogneva E.V.

Kharkov National Medical University, Kharkov, Ukraine

Headings: Gastroenterology

Distributed: Dovіdnik fahivtsya

Other version

CV

The article examines the advantages and disadvantages of a non-invasive method for diagnosing liver fibrosis – elastography. It is described to see this method of follow-up, the area of ​​congestion. Indicate the most effective types of elastography for various chronic liver diseases (chronic hepatitis B and C, non-alcoholic fatty liver disease, autoimmune disease of the hepatobiliary system and alcoholic liver disease). Analyzed the data of new randomized controlled studies.

The article discusses the advantages and disadvantages of a non-invasive method for diagnosing liver fibrosis — elastography. The types of this research method, fields of application are described. The most effective types of elastography for various chronic liver diseases (chronic hepatitis B and C, non-alcoholic fatty liver disease, autoimmune diseases of the hepatobiliary system and alcoholic liver disease) are indicated. Data from new randomized controlled trials were analyzed.

The article considers the advantages and disadvantages of the non-invasive method for diagnosing liver fibrosis—elastography. The types of this research method, applications were described. The most effective types of elastography for various chronic liver diseases were indicated (chronic hepatitis B and C, non-alcoholic fatty liver disease, autoimmune diseases of the hepatobiliary system and alcoholic liver disease). The latest research results were analyzed.

Keywords

chronic liver disease; liver fibrosis; elastography

chronic liver disease; liver fibrosis; elastography

chronic liver diseases; liver fibrosis; elastography

doi: http://dx.doi.org/10.22141/2308-2097.52.2.2018.132616

The most common causes of chronic liver disease are chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection , non-alcoholic fatty liver disease (NAFLD) and alcohol abuse (alcoholic liver disease – ALD). All of these diseases can lead to liver fibrosis. The end stage of liver fibrosis is cirrhosis, with potential complications such as portal hypertension, liver failure, and hepatocellular carcinoma (HCC). There is evidence that when the underlying etiological factor is eliminated, liver fibrosis may regress or stabilize [3]. Precise staging of liver fibrosis can be helpful in monitoring treatment response, disease progression, and prognosis.

Until recently, the severity of morphological changes in the liver was mainly assessed using needle biopsy, which is the reference standard for determining the stage of liver fibrosis and classifying necroinflammatory changes using various semi-quantitative scoring systems. The most commonly used scoring systems include the METAVIR score for chronic HBV or HCV infections and the Brunt score for non-alcoholic steatohepatitis (NASH) [1, 20]. All these systems (with the exception of the Ishak scale) evaluate the stages of fibrosis from F0 to F4, where F0 means no fibrosis, F1 – mild fibrosis; F2 – moderate fibrosis; F3 – severe fibrosis and F4 – cirrhosis. Despite its strengths, liver biopsy has several disadvantages: it is invasive and associated with the development of complications (approximately 3%), such as pain and bleeding, which limit the use of the method for repeat studies and monitoring of treatment outcomes and disease progression. In addition, a biopsy allows analysis of only a small part of the liver, about 1/50,000th of the total parenchyma, which leads to possible diagnostic errors [30]. Finally, liver biopsy, due to its invasiveness, cannot be used to monitor information on the rate of disease progression. All these limitations make liver biopsy an imperfect method, the shortcomings of which can lead to misinterpretation of the results.

Alternative, non-invasive liver assessment methods such as serum markers and image-based ultrasonographic and magnetic resonance (MR) imaging have been developed. Serum markers include simple measures such as platelet count, FIB-4 and more sophisticated proprietary scoring systems such as FibroTest/FibroSure (BioPredictive, France), FibroMeter (Echosens, France). Although easy to perform, these tests have limited accuracy in detecting intermediate stages of fibrosis and are generally considered less accurate than elastographic methods [8].

Principles of Elastography

Elastography, pioneered by Ophir et al. [28], is a non-invasive assessment of the mechanical properties of tissue, such as elasticity, which reflects the resistance to tissue deformation when exposed to a sound wave pulse and/or compression. In quantitative elastography methods, pressure is generated by the propagation of a transverse wave, which is generated momentarily, by a single mechanical impulse, or dynamically, by the continuous application of acoustic waves.

Quantitative elastography techniques include transient elastography (TE) and pulsed acoustic wave exposure (ARFI) techniques such as point shear elastography (pSWE) and 2D transverse wave elastography (2D SWE) [23]. The FibroScan system (Echosens, Paris, France) was the first commercially available TE system, introduced in Europe in 2003 and approved in the US by the Food and Drug Administration (FDA) in 2013. The FibroScan device provides a mechanical impulse of 50 Hz, followed by a change in the propagation speed of the generated wave. The ARFI elasticity nomenclature is not standardized in the literature. Although pSWE and 2D SWE use ARFI to generate shear waves, pSWE is often cited as an indicator of ARFI elasticity in published studies. To avoid confusion, in this review we use ARFI to describe the wave generation method and refer to the relevant implementations such as pSWE and 2D SWE.

Reliability and errors of elastographic methods

TE method

The error rate and reliability of TE was assessed in a study of 13,369 M-sensor examinations. The technique turned out to be erroneous in 3.1% of cases; however, unreliable measurements were obtained in another 15.8% of cases. Body mass index has been identified as a significant contributor to poor and/or unreliable results. The use of the XL probe has improved the reliability of TE in patients with NAFLD [33]. For example, in a study of 276 patients, reliable measurements were obtained in 73% of patients in the XL regimen, compared with only 50% of patients examined in the M-mode [26].

pSWE and 2D SWE methods

The information content of pSWE and 2D SWE was compared in 79 patients with measurements performed by three functional diagnostic specialists [40]. The failure rate was low for both methods (5% for 2D SWE and 1% for pSWE). There is also evidence that the experience of the examiner has an impact on pSWE [15], so elastography requires appropriate training.

MR elastography

The error rate of MR elastography is low. Unsuccessful results are usually associated with iron deposition in the liver, the presence of severe ascites, and an increase in body mass index [21, 38]. A recent meta-analysis including results from a study of 274 patients found that a change in stiffness values ​​of no more than 22%, measured at the same site using the same apparatus, indicates a true measure of stiffness with a confidence of 95% [31].

Thus, MR elastography and 2D SWE seem to provide the highest measurement success rate.

Chronic HBV and HCV infections

Knowledge of the stage of liver fibrosis in chronic HBV and HCV infections is essential for prognosis and subsequent treatment decisions. The combination of powerful direct-acting antiviral drugs recently developed for the treatment of chronic HCV infection [34] and the recent increase in the use of non-invasive tests to clarify the stage of liver fibrosis, as proposed by experts from the European Association for the Study of the Liver (EASL), has led to the fact that in HCV infection decreased frequency of liver biopsy [14, 18]. The American Association for the Study of Liver Diseases (AASLD) in the guidelines for chronic HBV infection indicates the feasibility of TE for non-invasive diagnosis of the stage of fibrosis [35].

Transient elastography

Several early studies reported excellent diagnostic performance of TE for detecting advanced fibrosis and cirrhosis in chronic HCV infection [5]. Similar results were subsequently reported by other studies in chronic HCV and HBV infections, although in some cases the efficacy of TE was reduced compared to serum markers due to a high proportion of unreliable results [45]. A meta-analysis confirmed the excellent diagnostic accuracy of TE for the diagnosis of cirrhosis, more effective than for the detection of moderate fibrosis [17]. It is recommended to use a combination of TE and serum markers to diagnose moderate fibrosis in chronic HCV infection [2].

ARFI methods became available later than TE, so they are less studied. These applications in chronic HBV and HCV infections demonstrate the high accuracy of methods for staging liver fibrosis. For example, in a study of 274 patients with chronic HCV infection [19], high specificity (90-94%) and sensitivity (84-91%) for the diagnosis of stage F3-F4, respectively, were reported.

2D SWE

2D SWE is also highly accurate in chronic HBV and HCV infections [37] but is less well understood than pSWE and TE. 2D SWE has been found to be an equivalent, if not better, diagnostic tool than TE for patients infected with HCV [22].

MR elastography

Given the limited availability and recent clinical use of MR elastography, we have few published data compared to TE and pSWE, with fewer prospective studies [44] and a lack of studies , including cohorts. According to published studies of chronic HCV or HBV infection, MR elastography has shown excellent accuracy in diagnosing fibrosis or cirrhosis for F2-F4, F3-F4, and F4 (95–99%, 94–100%, and 92–100%, respectively) [32].

EASL guidelines [9]

To rule out cirrhosis, all HCV patients should be evaluated with TE, if available. In the absence of TE, serum markers can be used.

Patients with HCV diagnosed with non-invasive cirrhosis do not need biopsy confirmation and should be screened for portal hypertension and the presence of HCC.

In chronic hepatitis B, TE is a better method for detecting liver fibrosis and cirrhosis than serum biomarkers.

In hepatitis B patients with active viremia (HBV DNA > 2000 IU/mL) and normal ALT, TE is the best way to detect liver fibrosis.

In inactive carriers (HBeAg negative, low viral load (HBV DNA < 2000 IU/mL) and normal ALT), TE may be used to rule out fibrosis and cirrhosis. Liver biopsy should be performed only in doubtful cases, after TE.

Among patients with elevated ALT levels, liver density measurements should be interpreted with caution, and in patients with very high ALT levels, TE should not be performed.

NAFLD and NASH

NAFLD is becoming a widespread pathology throughout the world due to an increase in the number of patients with obesity and diabetes. Liver fibrosis has been shown to be the strongest predictor of complications in patients with NAFLD [13], which motivates the search for reliable non-invasive methods for detecting liver fibrosis.

TE method

EASL experts for NAFLD management recommend TE as an affordable non-invasive method for assessing and monitoring liver fibrosis, while liver biopsy remains the gold standard for diagnosing fibrosis and cirrhosis [10]. The use of TE in patients with NAFLD is challenging due to the unreliability of the method in overweight or obese individuals using a standard M-sensor. The range of unreliable values ​​is large: 3.8–50% of patients are reported in whom the method was unreliable and/or failed [27]. A meta-analysis of the effectiveness of TE using an M-sensor in NAFLD (n = 854) [25] showed sensitivity and specificity for F2-F4 (79and 75%, respectively), F3-F4 (85 and 82%, respectively) and F4 (92 and 92%, respectively). As with chronic HBV or HCV infections, TE is more accurate in advanced fibrosis. The introduction of the XL probe resulted in more reliable results than with the use of the M probe in overweight or obese patients [29].

pSWE method

A preliminary study in patients with NAFLD [43] showed that pSWE performs very well in diagnosing stages F3-F4 and F4 of fibrosis. Subsequent studies have reported similar high accuracy in diagnosing fibrosis and differentiating between NASH and simple steatosis [16].

2D SWE

2D SWE is less validated in patients with NAFLD than pSWE and TE. A recent prospective study of patients with NAFLD (n = 291) compared 2D SWE, pSWE, and TE using an M-sensor [4]. When accounting for unreliable results, all methods had a similar rate of successful measurements (80%, 77%, and 81% for 2D SWE, TE, and pSWE, respectively). Two-dimensional SWE is better than pSWE for diagnosing moderate fibrosis (stage F2).

MP elastography

There is also evidence that MR elastography can differentiate between NASH and simple steatosis in patients with NAFLD [6], but this needs further confirmation.

EASL guidelines [9]

Screening for liver fibrosis is recommended in NAFLD patients, especially in patients diagnosed with metabolic syndrome or type 2 diabetes mellitus.

Non-invasive methods for assessing liver stiffness, including serum biomarkers and TEs, can be used as first-line tools to identify patients with advanced liver fibrosis or cirrhosis.

Evaluation of fibrosis progression in patients with NAFLD by TE should be performed every 3 years.

Liver disease of other etiologies

TE has also been used in the study of autoimmune liver diseases with good diagnostic results [41], although several studies have reported that acute inflammation resulting from autoimmune hepatitis (AIH) can affect liver stiffness [42]. TE has also been shown to be an accurate method for detecting fibrosis in primary biliary cirrhosis (PBC) [7], primary sclerosing cholangitis (PSC) [12], and alcoholic liver disease (ALD) [36].

pSWE methods have been used in autoimmune liver disease and ALD in a small number of studies [24]. The 2D SWE method has also been used in ALD, with similar accuracy compared to TE [36].

In the diagnosis of AIH [39] and PSC [11], a high diagnostic accuracy of MR elastography was noted, but so far this method has not been used in the study of ALD.

MR elastography is the most reliable technique in overweight or obese patients, with high fibrosis staging accuracy, although published data are still limited.

EASL Guidelines [9]

Patients with PBC or PSC can have a non-invasive assessment of fibrosis by TE.

TE in patients with ALD may be used to rule out advanced fibrosis or cirrhosis.

The progression of liver fibrosis in patients with PBC and PSC should also be monitored by TE.

Common bile duct or large hepatic duct strictures should be excluded in patients with PSC because obstructive cholestasis affects liver stiffness.

There is not yet enough evidence to recommend the use of non-invasive testing in AIH.

Thus, elastographic methods are currently accurate methods for the quantitative non-invasive diagnosis of liver fibrosis in a wide range of nosologies. The interpretation of the results should take into account the factors influencing the change in stiffness, technical limitations. MR elastography has slightly greater diagnostic accuracy than TE and ARFI, while providing a measure of stiffness over a larger area of ​​the liver. However, this method needs to be more carefully tested, and the high cost and limited availability may reduce the application of the method worldwide. ARFI techniques have shown a similar diagnostic capability to TE, and it can be assumed that in the future they will also become the recommended non-invasive methods for diagnosing liver fibrosis. A promising direction in the development of this type of diagnostics is the emergence of innovative methods, such as three-dimensional MR elastography, which can significantly improve the accuracy of determining fibrosis and steatosis in liver diseases.

Conflict of interest.  The authors declare that there is no conflict of interest in the preparation of this article.

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Hepatitis C Virus (HCV), RNA Qualitative Detection (Ultra-Sensitive Method) – Family Clinic at Home

Hepatitis C Virus (HCV, HCV) is an RNA-containing virus of the Flaviviridae family that infects the liver and leads to the development of chronic hepatitis C, cirrhosis of the liver and hepatocellular carcinoma. There are six known genotypes and many subtypes of the virus, which are of different importance in the progression of the disease and the effectiveness of antiviral therapy.

A modern method for diagnosing HCV is the real-time polymerase chain reaction method. Polymerase chain reaction (PCR) is a molecular diagnostic method that allows detecting fragments of the genetic material (RNA) of the virus at the early stages of the disease. It is characterized by high sensitivity and specificity and allows you to get the result in a relatively short time.

Real-time PCR detects viral RNA both qualitatively and quantitatively. Qualitative detection of the genetic material of the virus suggests the presence of the virus in the test material. The quantitative characteristic of the content of hepatitis C virus RNA in the studied biomaterial, that is, the determination of the viral load, makes it possible to evaluate the effectiveness of antiviral therapy and predict the course of the disease with the possible development of a chronic process and complications.

Determination of viral load on automated equipment allows the analysis of all 6 (1-6) HCV genotypes, has a high clinical specificity of the test (100%) and almost completely eliminates possible diagnostic errors at all stages of analysis.

The effectiveness of treatment is assessed by the amount of RNA before and during therapy. When assessing the effectiveness of ongoing antiviral therapy and predicting the development of a chronic process, an assessment of the amount of viral RNA in diagnostic units – IU / ml is used. If the virus concentration is less than 8×10^5 IU / ml (800,000 IU / ml), then the ongoing antiviral treatment is effective, if higher, then alternative therapy options should be considered. 5 IU/ml and determination of the HCV genotype are the most important parameters in predicting the disease and evaluating the effectiveness of therapy.

What is research used for?

To confirm the diagnosis of “viral hepatitis C”, to determine the quantitative content of the virus RNA.
To predict the course of viral hepatitis C.
To assess the effectiveness of ongoing antiviral therapy and decide on further treatment tactics.
When is the test scheduled?

When hepatitis C virus RNA is detected by qualitative methods or other tests for the diagnosis of this virus.
For acute and chronic viral hepatitis C.
When planning, during and after the end of antiviral therapy.
When evaluating the possibility of developing chronic hepatitis C, cirrhosis of the liver and hepatocellular carcinoma of the liver.

At least 3 hours after the last meal. You can drink water without gas. Do not smoke for 30 minutes prior to the study.

Reference values: not found.