This study sought to determine the prevalence of significant
liver disease in those subjects with serum
alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one
alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic
liver disease;
aspartate aminotransferase/platelet ratio index, FIB-4 and
alanine aminotransferase/
aspartate aminotransferase ratio were used to evaluate
liver fibrosis. The prevalence of significant
liver disease, by diagnoses and
fibrosis scores was compared between subjects with
alanine aminotransferase levels in the delta range (men, 42-45 IU/L; women, 26-34 IU/L) and in the newly suggested normal range (men, 15-42 IU/L; women, 10-26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic
liver disease including 366 with
cirrhosis. Compared to subjects with
alanine aminotransferase levels in the newly suggested normal range, subjects with
alanine aminotransferase levels in the delta range had a significantly higher rate of chronic
liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of
cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean
fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum
alanine aminotransferase may help to identify elderly patients at risk of significant
liver disease.