Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases
Aminotransferases, particularly alanine aminotransferase (ALT), are commonly used in the detection, diagnosis, and management of chronic liver diseases. ALT, a sensitive and cost-effective marker of liver injury, remains pivotal in predicting clinical outcomes and guiding interventions in several ch...
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| Language: | English |
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Elsevier
2025-01-01
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| Series: | Annals of Hepatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268125001243 |
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| author | Patrizia Burra Calogero Cammà Pietro Invernizzi Fabio Marra Maurizio Pompili |
| author_facet | Patrizia Burra Calogero Cammà Pietro Invernizzi Fabio Marra Maurizio Pompili |
| author_sort | Patrizia Burra |
| collection | DOAJ |
| description | Aminotransferases, particularly alanine aminotransferase (ALT), are commonly used in the detection, diagnosis, and management of chronic liver diseases. ALT, a sensitive and cost-effective marker of liver injury, remains pivotal in predicting clinical outcomes and guiding interventions in several chronic liver diseases including metabolic dysfunction-associated steatotic liver disease, and chronic viral hepatitis. This study aims to explore the evolving role of ALT as a biomarker. A comprehensive review of evidence was conducted, focusing on studies evaluating ALT thresholds, diagnostic accuracy, and integration with non-invasive liver assessment tools. Special emphasis was given to novel approaches, including artificial intelligence-driven algorithms. Expert opinions from hepatology care perspectives were considered to assess the practical implications of refining ALT-based diagnostic strategies. ALT levels are influenced by diverse factors such as age, gender, and metabolic risks, challenging the use of specific thresholds as biomarker of disease and prognosis. Emerging evidence suggests redefining ALT ranges to enhance sensitivity and accuracy in detecting liver abnormalities. The integration of ALT with advanced non-invasive diagnostic tools, artificial intelligence, and comprehensive patient assessments can optimize early detection of liver disease, thus reducing underdiagnosis, particularly in asymptomatic or vulnerable populations.This work highlights the urgency to tailor the diagnostic approaches in primary and specialised care, ensuring timely and targeted intervention to effectively address the global burden of liver diseases. |
| format | Article |
| id | doaj-art-eaf2f00d44ba42bbbd22c38bc7ab8eda |
| institution | OA Journals |
| issn | 1665-2681 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj-art-eaf2f00d44ba42bbbd22c38bc7ab8eda2025-08-20T02:04:49ZengElsevierAnnals of Hepatology1665-26812025-01-0130110190010.1016/j.aohep.2025.101900Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseasesPatrizia Burra0Calogero Cammà1Pietro Invernizzi2Fabio Marra3Maurizio Pompili4Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, ItalySection of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, ItalyDivision of Gastroenterology, Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Corresponding author.; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.Department of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Medical and Surgical Sciences, Catholic University of the Sacred Heart, A. Gemelli Hospital IRCCS, Rome, ItalyAminotransferases, particularly alanine aminotransferase (ALT), are commonly used in the detection, diagnosis, and management of chronic liver diseases. ALT, a sensitive and cost-effective marker of liver injury, remains pivotal in predicting clinical outcomes and guiding interventions in several chronic liver diseases including metabolic dysfunction-associated steatotic liver disease, and chronic viral hepatitis. This study aims to explore the evolving role of ALT as a biomarker. A comprehensive review of evidence was conducted, focusing on studies evaluating ALT thresholds, diagnostic accuracy, and integration with non-invasive liver assessment tools. Special emphasis was given to novel approaches, including artificial intelligence-driven algorithms. Expert opinions from hepatology care perspectives were considered to assess the practical implications of refining ALT-based diagnostic strategies. ALT levels are influenced by diverse factors such as age, gender, and metabolic risks, challenging the use of specific thresholds as biomarker of disease and prognosis. Emerging evidence suggests redefining ALT ranges to enhance sensitivity and accuracy in detecting liver abnormalities. The integration of ALT with advanced non-invasive diagnostic tools, artificial intelligence, and comprehensive patient assessments can optimize early detection of liver disease, thus reducing underdiagnosis, particularly in asymptomatic or vulnerable populations.This work highlights the urgency to tailor the diagnostic approaches in primary and specialised care, ensuring timely and targeted intervention to effectively address the global burden of liver diseases.http://www.sciencedirect.com/science/article/pii/S1665268125001243AminotransferasesAlanine aminotransferase (ALT)Chronic liver diseaseBiomarkersPrimary care |
| spellingShingle | Patrizia Burra Calogero Cammà Pietro Invernizzi Fabio Marra Maurizio Pompili Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases Annals of Hepatology Aminotransferases Alanine aminotransferase (ALT) Chronic liver disease Biomarkers Primary care |
| title | Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| title_full | Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| title_fullStr | Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| title_full_unstemmed | Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| title_short | Does the hepatologist still need to rely on aminotransferases in clinical practice? A reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| title_sort | does the hepatologist still need to rely on aminotransferases in clinical practice a reappraisal of the role of a classic biomarker in the diagnosis and clinical management of chronic liver diseases |
| topic | Aminotransferases Alanine aminotransferase (ALT) Chronic liver disease Biomarkers Primary care |
| url | http://www.sciencedirect.com/science/article/pii/S1665268125001243 |
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