ELEVATED AST AND ALT RESULTS AND AN AST/ALT RATIO BETWEEN 0.7 AND 1.0 LINKED TO AN INCREASED RISK OF NASH IN PATIENTS WITH DIABETES
AACE ePoster Library. Smyth C. 05/13/15; 97784; 274
Dr. Carol Smyth
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Abstract
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Objective
Nonalcoholic steatohepatitis (NASH) is thought to affect 5% of Americans, with even higher prevalence in those with diabetes (DM). There is no known lab test to screen for NASH. We studied a national lab test database (Medivo Inc., NY, NY) to search for lab tests that may be used to screen.
Methods
We looked at 145,059 patients with DM who had lab tests July 2013 - June 2014; tests studied included AST, ALT and AST/ALT ratio, ALK Phos, and creatinine. We also looked at 71 patients with diagnosis of NASH and 1,500 patients with DM tested July 2013 -June 2014 who had results of all tests. Logistic regression was used to determine what test results have significant association with NASH. Finally, we studied a group of patients (N = 225,444) tested July 2013 - June 2014, and compared the risk of NASH in patients with DM (N = 109,594) vs. those without DM (N =115,850). We defined an AST/ALT ratio between 0.7 - 1.0 and an abnormal AST of >40 U/L as indicating NASH/NASH risk.
Results
In the first study, 126 patients (0.087%) had an ICD-9 code for NASH; 125 had ICD-9 codes for cirrhosis/other liver diseases (0.086%); 5 had an ICD-9 code for alcoholism (0.003%); 8,794 (6.06%) had an abnormal AST; 15,759 (10.86%) had an abnormal ALT; 8,927 (6.15%) had an abnormal ALK Phos; and 23,112 (15.93%) had an abnormal creatinine. In the second study, we found that AST and ALT were significant predictors of NASH in patients with DM. Our study showed that patients with DM with elevated AST and/or ALT were 1.5 - 2 times more likely to have NASH (OR (AST)=0.95, OR(ALT)=1.1, p< 0.01) than people with abnormal results in other tests. And in the third study, we found that 5,072 (4.63%) of patients with DM were at elevated risk for NASH with an AST/ALT ratio between 0.7 - 1.0, and AST > 40; 2,547 (2.20%) of patients without DM also met the criteria. Moreover, we found that DM has significant association with NASH. DM patients were 116% more likely to have NASH than patients without DM (OR=0.77, p<0.001).
Discussion
Our analysis suggests that elevated AST and ALT lab test results, and an AST/ALT ratio between 0.7 - 1.0 are associated with NASH/ risk for NASH. Further, we found a significantly higher risk of NASH in patients with DM compared to those without DM.
Conclusions
Patients with DM are at higher risk for NASH compared to those without DM. We also found that the results of AST, ALT, AST/ALT ratio lab tests may be associated with NASH in patients with and without DM. More study is needed to confirm these results, to compare them with histological findings, and to study patient demographics to identify populations that will benefit from screening for NASH.
Nonalcoholic steatohepatitis (NASH) is thought to affect 5% of Americans, with even higher prevalence in those with diabetes (DM). There is no known lab test to screen for NASH. We studied a national lab test database (Medivo Inc., NY, NY) to search for lab tests that may be used to screen.
Methods
We looked at 145,059 patients with DM who had lab tests July 2013 - June 2014; tests studied included AST, ALT and AST/ALT ratio, ALK Phos, and creatinine. We also looked at 71 patients with diagnosis of NASH and 1,500 patients with DM tested July 2013 -June 2014 who had results of all tests. Logistic regression was used to determine what test results have significant association with NASH. Finally, we studied a group of patients (N = 225,444) tested July 2013 - June 2014, and compared the risk of NASH in patients with DM (N = 109,594) vs. those without DM (N =115,850). We defined an AST/ALT ratio between 0.7 - 1.0 and an abnormal AST of >40 U/L as indicating NASH/NASH risk.
Results
In the first study, 126 patients (0.087%) had an ICD-9 code for NASH; 125 had ICD-9 codes for cirrhosis/other liver diseases (0.086%); 5 had an ICD-9 code for alcoholism (0.003%); 8,794 (6.06%) had an abnormal AST; 15,759 (10.86%) had an abnormal ALT; 8,927 (6.15%) had an abnormal ALK Phos; and 23,112 (15.93%) had an abnormal creatinine. In the second study, we found that AST and ALT were significant predictors of NASH in patients with DM. Our study showed that patients with DM with elevated AST and/or ALT were 1.5 - 2 times more likely to have NASH (OR (AST)=0.95, OR(ALT)=1.1, p< 0.01) than people with abnormal results in other tests. And in the third study, we found that 5,072 (4.63%) of patients with DM were at elevated risk for NASH with an AST/ALT ratio between 0.7 - 1.0, and AST > 40; 2,547 (2.20%) of patients without DM also met the criteria. Moreover, we found that DM has significant association with NASH. DM patients were 116% more likely to have NASH than patients without DM (OR=0.77, p<0.001).
Discussion
Our analysis suggests that elevated AST and ALT lab test results, and an AST/ALT ratio between 0.7 - 1.0 are associated with NASH/ risk for NASH. Further, we found a significantly higher risk of NASH in patients with DM compared to those without DM.
Conclusions
Patients with DM are at higher risk for NASH compared to those without DM. We also found that the results of AST, ALT, AST/ALT ratio lab tests may be associated with NASH in patients with and without DM. More study is needed to confirm these results, to compare them with histological findings, and to study patient demographics to identify populations that will benefit from screening for NASH.
Objective
Nonalcoholic steatohepatitis (NASH) is thought to affect 5% of Americans, with even higher prevalence in those with diabetes (DM). There is no known lab test to screen for NASH. We studied a national lab test database (Medivo Inc., NY, NY) to search for lab tests that may be used to screen.
Methods
We looked at 145,059 patients with DM who had lab tests July 2013 - June 2014; tests studied included AST, ALT and AST/ALT ratio, ALK Phos, and creatinine. We also looked at 71 patients with diagnosis of NASH and 1,500 patients with DM tested July 2013 -June 2014 who had results of all tests. Logistic regression was used to determine what test results have significant association with NASH. Finally, we studied a group of patients (N = 225,444) tested July 2013 - June 2014, and compared the risk of NASH in patients with DM (N = 109,594) vs. those without DM (N =115,850). We defined an AST/ALT ratio between 0.7 - 1.0 and an abnormal AST of >40 U/L as indicating NASH/NASH risk.
Results
In the first study, 126 patients (0.087%) had an ICD-9 code for NASH; 125 had ICD-9 codes for cirrhosis/other liver diseases (0.086%); 5 had an ICD-9 code for alcoholism (0.003%); 8,794 (6.06%) had an abnormal AST; 15,759 (10.86%) had an abnormal ALT; 8,927 (6.15%) had an abnormal ALK Phos; and 23,112 (15.93%) had an abnormal creatinine. In the second study, we found that AST and ALT were significant predictors of NASH in patients with DM. Our study showed that patients with DM with elevated AST and/or ALT were 1.5 - 2 times more likely to have NASH (OR (AST)=0.95, OR(ALT)=1.1, p< 0.01) than people with abnormal results in other tests. And in the third study, we found that 5,072 (4.63%) of patients with DM were at elevated risk for NASH with an AST/ALT ratio between 0.7 - 1.0, and AST > 40; 2,547 (2.20%) of patients without DM also met the criteria. Moreover, we found that DM has significant association with NASH. DM patients were 116% more likely to have NASH than patients without DM (OR=0.77, p<0.001).
Discussion
Our analysis suggests that elevated AST and ALT lab test results, and an AST/ALT ratio between 0.7 - 1.0 are associated with NASH/ risk for NASH. Further, we found a significantly higher risk of NASH in patients with DM compared to those without DM.
Conclusions
Patients with DM are at higher risk for NASH compared to those without DM. We also found that the results of AST, ALT, AST/ALT ratio lab tests may be associated with NASH in patients with and without DM. More study is needed to confirm these results, to compare them with histological findings, and to study patient demographics to identify populations that will benefit from screening for NASH.
Nonalcoholic steatohepatitis (NASH) is thought to affect 5% of Americans, with even higher prevalence in those with diabetes (DM). There is no known lab test to screen for NASH. We studied a national lab test database (Medivo Inc., NY, NY) to search for lab tests that may be used to screen.
Methods
We looked at 145,059 patients with DM who had lab tests July 2013 - June 2014; tests studied included AST, ALT and AST/ALT ratio, ALK Phos, and creatinine. We also looked at 71 patients with diagnosis of NASH and 1,500 patients with DM tested July 2013 -June 2014 who had results of all tests. Logistic regression was used to determine what test results have significant association with NASH. Finally, we studied a group of patients (N = 225,444) tested July 2013 - June 2014, and compared the risk of NASH in patients with DM (N = 109,594) vs. those without DM (N =115,850). We defined an AST/ALT ratio between 0.7 - 1.0 and an abnormal AST of >40 U/L as indicating NASH/NASH risk.
Results
In the first study, 126 patients (0.087%) had an ICD-9 code for NASH; 125 had ICD-9 codes for cirrhosis/other liver diseases (0.086%); 5 had an ICD-9 code for alcoholism (0.003%); 8,794 (6.06%) had an abnormal AST; 15,759 (10.86%) had an abnormal ALT; 8,927 (6.15%) had an abnormal ALK Phos; and 23,112 (15.93%) had an abnormal creatinine. In the second study, we found that AST and ALT were significant predictors of NASH in patients with DM. Our study showed that patients with DM with elevated AST and/or ALT were 1.5 - 2 times more likely to have NASH (OR (AST)=0.95, OR(ALT)=1.1, p< 0.01) than people with abnormal results in other tests. And in the third study, we found that 5,072 (4.63%) of patients with DM were at elevated risk for NASH with an AST/ALT ratio between 0.7 - 1.0, and AST > 40; 2,547 (2.20%) of patients without DM also met the criteria. Moreover, we found that DM has significant association with NASH. DM patients were 116% more likely to have NASH than patients without DM (OR=0.77, p<0.001).
Discussion
Our analysis suggests that elevated AST and ALT lab test results, and an AST/ALT ratio between 0.7 - 1.0 are associated with NASH/ risk for NASH. Further, we found a significantly higher risk of NASH in patients with DM compared to those without DM.
Conclusions
Patients with DM are at higher risk for NASH compared to those without DM. We also found that the results of AST, ALT, AST/ALT ratio lab tests may be associated with NASH in patients with and without DM. More study is needed to confirm these results, to compare them with histological findings, and to study patient demographics to identify populations that will benefit from screening for NASH.
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