REVISED CUTOFF VALUES OF SERUM AMINOTRANSFERASE IN DETECTING VIRAL-HEPATITIS AMONG CAPD PATIENTS - EXPERIENCE FROM TAIWAN, AN ENDEMIC AREA FOR HEPATITIS-B

Background. To determine the best cutoff values of aspartate aminotran sferase (AST) and alanine aminotransferase (ALT) in detecting viral he patitis C infection among patients of continuous ambulatory peritoneal dialysis (CAPD). Methods, 90 (44 male and 46 female) CAPD patients an d 526 adult controls (266 male, 260 female) were enrolled, Serum AST a nd ALT were measured by an auto-analyser monthly. Serum HBsAg was exam ined using a RIA method and anti-HCV be an second-generation EIA metho d. The best cutoff values of AST and AET for detecting viral hepatitis were obtained from the ROC (receiver-operating characteristic) curve, Results. The prevalence of anti-HCV(+) was significantly higher in CA PD patients (16.7%) than in normal controls (4.9%), while that of HBsA g(+) was similar in both groups. CAPD patients had significantly lower levels of serum aminotransferases compared to normal controls. Mean A ST were 23.8 IU/l in normal control and 18.8 IU/l in the CAPD patients (P < 0.001). Mean ALT were 21.9 IU/l in normal controls and 15.3 IU/l in the CAPD patients (P<0.001). CAPD patients with HCV infection had higher serum AST and ALT levels than those without. However, HBV infec tion did not cause significant serum aminotransferase elevation in pat ients. The conventional cutoff values of AST (40 IU/l) and ALT (40 IU/ l) for detecting viral hepatitis yielded only a sensitivity of 27.3 an d 18.2% respectively; on the contrary, our revised cutoff values of AS T (24 IU/l) and ALT (17 IU/l) had better sensitivities (AST, 72.7%; AL T, 63.6%). For serial aminotransferase values, the sensitivity of AST and ALT for detecting HCV were 36.4 and 27.3% by conventional criteria , and were both 81.8%, by our newly revised criteria, Conclusions, Ser um aminotransferase cutoff values should be modified for screening vir al hepatitis in a CAPD population, Our new cutoff criteria had importa nt clinical implications in providing benefits of earlier detection an d possible prevention from chronic hepatic deteriorations.