Clinical Implications of Alanine Transaminase Level in the Diagnostic Accuracy of Alpha-Fetoprotein for Predicting Hepatocellular Carcinoma in Patients with Hepatis B Infection

Abstract Background Abnormally elevated AFP level is often observed in patients with chronic hepatitis infections without evident of (hepatocellular carcinoma) HCC. Our study aimed to investigate the influence of alanine transaminase (ALT) on the accuracy of alpha-fetoprotein (AFP) for detecting HCC. Methods This retrospective study recruited 799 patients with HCC, cirrhosis and chronic hepatitis due to hepatitis B infection and healthy adults between July 2017 and January 2019. Comparisons of the area under the receiver-operating curves (AUCs) for detecting HCC in different ALT levels were calculated. Results Serum ALT and gamma-glutamyl transferase level were significantly associated with elevated AFP in patients without HCC. The AUC of AFP was higher in patients with ALT ≤ 2 upper limit of normal (ULN) than in patients with ALT > 2ULN (0.806 vs 0.611, P 2ULN (0.769 vs 0.769, P = 0.68). AFP/(ALT×AST) was better than AFP in patients with ALT > 2ULN for detecting HCC (P <0.001). Conclusions Higher ALT level might impair the accuracy of AFP for diagnosing HCC. AFP tests showed better accuracy in patients with ALT ≤ 2 ULN whereas AFP/(ALT×AST) ratio was recommended in patients with elevated ALT level.