Relationship of Aminotransferases to Liver Histological Status in Chronic Hepatitis C

Objectives: Serum aminotransferase levels characteristically fluctuate in chronic hepatitis C, but their relationship to grade (i.e., inflammatory activity) and stage (i.e., degree of fibrosis) of liver disease is uncertain. We therefore correlated aminotransferase levels and liver biopsy findings in 90 patients with serologically confirmed chronic hepatitis C. Methods: Mode of transmission; disease duration; symptoms and signs of liver disease; alcohol intake; autoantibody, HIV, and hepatitis B virus status; and liver biochemistries were obtained from records. Liver biopsies were 1) given a morphological diagnosis, 2) evaluated for features of chronic hepatitis C, and 3) scored with a histological activity index. Results: Individual aminotransferase levels were not related to clinical or laboratory variables, nor were they reliably predictive of morphological diagnosis. No histological characteristics were associated with a particular range of aminolransferase values, except aminotransferases >350 U/L, which were associated with piecemeal necrosis. Although mean values of aminotransferases were significantly lower among patients with chronic persistent hepatitis (CPH) (i.e., with minimal activity) compared with chronic active hepatitis (CAH) (mild to moderate activity) (ALT 110 U/L ± 71 SI) vs 256 ± 211; AST 57 U/L ± 34 vs 123 ± 88) and in the absence of piecemeal necrosis compared with in its presence (ALT 133 ± 84 vs 207 ± 149; AST 73 ± 47 vs 120 ± 83), overlap of values was considerable between different histological groups. Conclusion: Aminotransferases do not predict liver histological status in chronic hepatitis C, although ≥ 10‐fold elevations suggest that piecemeal necrosis is present.